Published online Dec 16, 2021. doi: 10.4253/wjge.v13.i12.673
Peer-review started: March 18, 2021
First decision: July 17, 2021
Revised: July 31, 2021
Accepted: December 2, 2021
Article in press: December 2, 2021
Published online: December 16, 2021
Conventional optical colonoscopy is considered the gold standard investigation for colorectal tract pathology including colorectal malignancy, polyps and inflammatory bowel disease. Inherent limitations exist with current generation endoscopic technologies, including, but not limited to, patient discomfort, endoscopist fatigue, narrow field of view and missed pathology behind colonic folds. Rapid developments in medical robotics have led to the emergence of a variety of next-generation robotically-augmented technologies that could overcome these limitations.
To provide a comprehensive summary of recent developments in the application of robotics in lower gastrointestinal tract endoscopy.
A systematic review of the literature was performed from January 1, 2000 to the January 7, 2021 using EMBASE, MEDLINE and Cochrane databases. Studies reporting data on the use of robotic technology in ex vivo or in vivo animal and human experiments were included. In vitro studies (studies using synthetic colon models), studies evaluating non-robotic technology, robotic technology aimed at the upper gastrointestinal tract or paediatric endoscopy were excluded. System ergonomics, safety, visualisation, and diagnostic/therapeutic capabilities were assessed.
Initial literature searching identified 814 potentially eligible studies, from which 37 were deemed suitable for inclusion. Included studies were classified according to the actuation modality of the robotic device(s) as electromechanical (EM) (n = 13), pneumatic (n = 11), hydraulic (n = 1), magnetic (n = 10) and hybrid (n = 2) mechanisms. Five devices have been approved by the Food and Drug Administration, however most of the technologies reviewed remain in the early phases of testing and development. Level 1 evidence is lacking at present, but early reports suggest that these technologies may be associated with improved pain and safety. The reviewed devices appear to be ergonomically capable and efficient though to date no reports have convincingly shown diagnostic or therapeutic superiority over conventional colonoscopy.
Significant progress in robotic colonoscopy has been made over the last couple of decades. Improvements in design together with the integration of semi-autonomous and autonomous systems over the next decade will potentially result in robotic colonoscopy becoming more commonplace.
Core Tip: Robotic technologies have the potential to transform lower gastrointestinal tract endoscopy into a quicker, safer, more reliable and less painful procedure. In the long term, benefits for patients, endoscopists and the wider healthcare industry are foreseeable, though these have yet to be convincingly demonstrated in human trials. Most studies to date have employed ex vivo modelling and high quality level 1 evidence is currently lacking in this field. Robotic technologies are evolving with such rapidity at the moment, that future robo-endoscopic systems are likely to look and behave very differently to conventional master-slave systems currently in use. Exciting developments in 3D printing, soft robotics, autonomous functionality and augmented reality are likely to converge to lead to the development of truly next generation robotic endoscopy devices.