Robotic Colonoscopy and Beyond: Insights into Modern Lower Gastrointestinal Endoscopy

Abstract

Lower gastrointestinal endoscopy is considered the gold standard for the diagnosis and removal of colonic polyps. Delays in colonoscopy following a positive fecal immunochemical test increase the likelihood of advanced adenomas and colorectal cancer (CRC) occurrence. However, patients may refuse to undergo conventional colonoscopy (CC) due to fear of possible risks and pain or discomfort. In this regard, patients undergoing CC frequently require sedation to better tolerate the procedure, increasing the risk of deep sedation or other complications related to sedation. Accordingly, the use of CC as a first-line screening strategy for CRC is hampered by patients’ reluctance due to its invasiveness and anxiety about possible discomfort. To overcome the limitations of CC and improve patients’ compliance, several studies have investigated the use of robotic colonoscopy (RC) both in experimental models and in vivo. Self-propelling robotic colonoscopes have proven to be promising thanks to their peculiar dexterity and adaptability to the shape of the lower gastrointestinal tract, allowing a virtually painless examination of the colon. In some instances, when alternatives to CC and RC are required, barium enema (BE), computed tomographic colonography (CTC), and colon capsule endoscopy (CCE) may be options. However, BE and CTC are limited by the need for subsequent investigations whenever suspicious lesions are found. In this narrative review, we discussed the current clinical applications of RC, CTC, and CCE, as well as the advantages and disadvantages of different endoscopic procedures, with a particular focus on RC.

Application of micro/nanorobot in medicine

“…Its larger size relative to microscopic objects can potentially cause discomfort or injury to patients during the procedure. Moreover, there are inherent limitations in observing and operating in certain blind spots within the intestine during examinations ( Tapia-Siles et al, 2016 ; Tumino et al, 2023 ). In response to these challenges, technological advancements have led to the development of non-invasive endoscopic capsules and capsule endoscopes that can actively navigate within the intestinal tract under magnetic field guidance.…”

“…While Chimeric Antigen Receptor T (CAR-T) cell therapy has shown promise in treating hematological malignancies, its efficacy in solid tumors is curtailed by physical barriers and the immune microenvironment (Ma et al, 2019;Li et al, 2021). Addressing this, Tang et al (2023) have engineered a living micro-robot using CAR-T cells, which are augmented with immune magnetic beads through click conjugation (see in Figure 3D). This construct is magnetically steerable and capable of navigating fluids and circumventing obstacles.…”

Effect of Betty Neuman's systemic model on the anxiety of patients undergoing endoscopy: A randomized control trial

“…While endoscopy proves effective in early disease detection, thereby enhancing patient survival and reducing treatment costs, it is not without associated complications [6]. Anxiety emerges as a fundamental concern for patients undergoing diagnostic and therapeutic procedures [7], representing an unpleasant state of worry or pressure prevalent in various facets of human life [8]. Elevated anxiety levels during invasive procedures like endoscopy not only contribute to complications but also result in adverse effects, prolonged procedure times, increased sedative drug requirements, and hindered patient recovery [1].…”

“…Previous research has yielded varied outcomes regarding factors influencing anxiety in endoscopy patients [1]. In the realm of nursing studies, a predominant focus revolves around the objective of pain relief in patient care [7]. Numerous studies have demonstrated the positive impact of interventions such as music therapy and relaxation on alleviating pain and anxiety in individuals undergoing endoscopy [4].…”