Self-propelled soft robotic endoscopes for next-generation gastrointestinal surgery (ROBOGAST)

Lead Research Organisation: Imperial College London
Department Name: Mechanical Engineering

Abstract

Gastrointestinal cancers, including oesophagus, stomach and colon, are among the top ten cancers worldwide. Minimally invasive surgery of early gastrointestinal cancer and other digestive diseases offer important advantages compared to traditional open surgery in terms of reduced trauma and faster patient recovery. However, there are several limitations to current endoscopes including distal force transmission, triangulation of instruments, lack of bimanual tissue manipulations and visual-spatial orientation. Thus interventional endoscopy requires considerable experience and involves complex and time-consuming workflows. As a result, a sizeable amount of endoscopic interventions fail to reach the end of the colon and the small intestine because of their tortuous nature. Due to the current COVID-19 pandemic, endoscopy units nationwide have been struggling with capacity to perform gastrointestinal endoscopies resulting in a delay to diagnosis and treatment, impacting patient morbidity and mortality. Improving access to flexible endoscopy for diagnosis and treatment, and facilitating its deployment safely and affordably, should therefore be a priority and is a pressing clinical need.

This research aims to transform early diagnosis and minimally invasive intervention of the gastrointestinal tract, including the small intestine. To this end we will develop the underlying technology necessary to achieve autonomous self-propelled locomotion for the next generation of soft robotic endoscopes. Departing from the conventional push-endoscopy paradigm will reduce the discomfort associated to early diagnosis and will allow endoscopists who are less skilled in therapeutic procedures, outside secondary or tertiary care, to perform endoluminal and potentially transluminal surgery. Our focus on affordability aims to address the growing demand for single-use medical devices driven by infectious diseases, and to reduce the financial barriers that are preventing the wider use of surgical robotics in low-income countries.

Publications

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Franco E (2022) Model-Based Eversion Control of Soft Growing Robots With Pneumatic Actuation in IEEE Control Systems Letters

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Franco E (2022) Energy shaping control of underactuated mechanical systems with fluidic actuation in International Journal of Robust and Nonlinear Control

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Franco E (2022) Energy Shaping Control of Hydraulic Soft Continuum Planar Manipulators in IEEE Control Systems Letters

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Treratanakulchai S (2022) Development of a 6 DOF Soft Robotic Manipulator with Integrated Sensing Skin

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Treratanakulchai S (2023) Model-free Position Control of a Soft Continuum Manipulator in Cartesian Space

 
Description Significant new knowledge generated: in this project we focused on self-propelled locomotion and robotics for endoluminal surgery. Over the past 15 months, we have developed a soft growing structure that is actuated by compressed gas and that unfolds like a sock inside the GI tract. This will allow to reduce patient discomfort during endoscopies, since the instrument does not have to be pused from the back.

Important new research questions: we have identified a range of potential solutions to steer the soft growing structure insude the GI tract, which will allow to reduce the duration of endoscopies, patient discomfort, and learning curve for clinicians. These include: 1) photoactive materials, which contract when exposed to light, and can be used to directly steer the growing structure; 2) fluidic circuits "printed" on the soft growing structure and including photoactive valves; 3) advanced control theory that accounts for the dynamics of the pressurised gas in the growing structure.
The resulting research questions concern the concurrent optimisation of design and control of the soft growing structure in an holistic fashion. This could result in a new class of soft growing structures that can steer locally to follow the GI anatomy, and that can be operated semi-autonomously by non-expert clincians outside of specialised units.

New research networks/collaborations/partnerships: we have brought together this project, ROBOGAST, which focused on self-propelled locomotion and robotics, and MARS, which explored how to diagnose and treat disease in one go. This collaboration has led to a THT Phase 2 proposal that aims to
1. address pain in colonoscopy, by engineering next generation, self-propelled steerable robots that unfold into the GI tract
2. improve precision and reduce recurrence, by integrating optical and state of the art molecular diagnostics delivered through smart fibre technology
3. address the learning curve and improve capacity, by introducing staged autonomy in the clinical workflow of endoluminal diagnosis and surgery.
Exploitation Route The end users of this research are primarily clinicians in the fields of gastroenterology and gastrointestinal surgery. Secondary users include clinicians in the areas of urology, cardiovascular and thoracic surgery, and ear, nose and throat surgery.
We have put together a team of technical and clinical investigators co-located in the Hamlyn Centre which will continue this research.
We will also interact with researchers and clinicians from the Chinese University of Hong Kong, Mahidol University, Thailand, and from Institut Teknologi Bandung, Indonesia, to ensure that affordability remains a key priority for the resulting technologies.
In 5 years, we aim to create a new, soft robotic endoscope that can reach the small bowels, deploy optical and spectrometric sensing to detect disease automatically, and can remove tissue with a combination of laser ablation or robotic excision - all proven in vivo.
Sectors Healthcare