Hydro-jet propelled colonoscopy: proof of concept in a phantom colon
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and Other Interventional Techniques
NEW TECHNOLOGY
Hydro‑jet propelled colonoscopy: proof of concept in a phantom colon Stuart A. Coleman1 · Markus Pakleppa2 · Alfred Cuschieri1 Received: 3 March 2020 / Accepted: 3 October 2020 © The Author(s) 2020
Abstract Background Colonoscopy is a widely used and effective procedure, but it often causes patient discomfort and its execution requires considerable skill and training. We demonstrate an alternative approach to colonoscope propulsion with the potential to minimise patient discomfort by reducing the forces exerted on the colonic wall and mesentery, and to reduce the level of skill required for execution. Methods A prototype colonoscopic device is described, consisting of a tethered capsule that is propelled and manoeuvred through a water-filled colon (hydro-colonoscopy) by an array of water jets. As an initial proof of concept, experiments were performed to assess the ability of the device to navigate through a simplified PVA cryogel human colon phantom arranged in various anatomical configurations. Results The prototype was capable of successfully navigating through three out of four colon configurations: a simple layout, alpha loop and reverse alpha loop. It was unable to negotiate the fourth configuration involving an “N loop”, but this was attributed to problems with the colon phantom. In the successful test replicates, mean complete insertion (i.e. caecal intubation) time was 4.7 min. Measured pressures, temperatures and forces exerted on the colon appeared to be within a physiologically acceptable range. The results demonstrate the viability of propelling a colonoscope through a colon phantom using hydro-jets. Conclusions Results indicate that this approach has the potential to enable rapid and safe caecal intubation. This suggests that further development towards clinical translation is worthwhile. Keywords Colonoscope · Water · Jet · Propulsion · Colon · Phantom Flexible push colonoscopy remains the gold standard test for the diagnosis of colorectal disease. Although it is safe and used widely, it causes patient discomfort, largely due to the colonoscope pressing on the colonic walls as it is pushed through flexures, especially during looping [1]. This discomfort reduces patient compliance for routine colonoscopy [2] and means that the procedure is usually carried out under sedation. Colonoscopy is also a technically difficult procedure, requiring substantial training to acquire the skills required for proficient execution [3]. Furthermore, a substantial and costly amount of physician time is required to
* Stuart A. Coleman [email protected] 1
Institute of Medical Science and Technology, University of Dundee, Dundee DD21FD, UK
Discipline of Engineering, University of Dundee, Dundee, UK
2
advance the colonoscope through the colon prior to detailed colonoscopic examination [4]. These issues may be addressed using an alternative means of colonoscope propulsion, instead of push colonoscopy. Various alternative propulsion approaches have
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