Frontiers of Robotic Gastroscopy: A Comprehensive Review of Robotic Gastroscopes and Technologies

Abstract

Upper gastrointestinal (UGI) tract pathology is common worldwide. With recent advancements in robotics, innovative diagnostic and treatment devices have been developed and several translational attempts made. This review paper aims to provide a highly pictorial critical review of robotic gastroscopes, so that clinicians and researchers can obtain a swift and comprehensive overview of key technologies and challenges. Therefore, the paper presents robotic gastroscopes, either commercial or at a progressed technology readiness level. Among them, we show tethered and wireless gastroscopes, as well as devices aimed for UGI surgery. The technological features of these instruments, as well as their clinical adoption and performance, are described and compared. Although the existing endoscopic devices have thus far provided substantial improvements in the effectiveness of diagnosis and treatment, there are certain aspects that represent unwavering predicaments of the current gastroenterology practice. A detailed list includes difficulties and risks, such as transmission of communicable diseases (e.g., COVID-19) due to the doctor-patient proximity, unchanged learning curves, variable detection rates, procedure-related adverse events, endoscopists' and nurses' burnouts, limited human and/or material resources, and patients' preferences to choose non-invasive options that further interfere with the successful implementation and adoption of routine screening. The combination of robotics and artificial intelligence, as well as remote telehealth endoscopy services, are also discussed, as viable solutions to improve existing platforms for diagnosis and treatment are emerging.

Keywords: artificial intelligence; gastric cancer; gastroscopy; machine learning; robotic gastroscopy.

Figure 1

Commercially available gastroscopes: (A) Olympus gastroscope (courtesy of Olympus Corp.) [31]; (B) EG Scan gastroscope (IntroMedic, Seoul, Korea; courtesy of IntroMedic Ltd.); (C) PillCam^TM capsule endoscope [35,36,37]; (D) MiroCam-Navi system by Intromedic Ltd. (Seoul, Korea) [38]; (E) Navicam by Ankon Technologies Co., Ltd. (Wuhan, Shanghai, China; courtesy of ANKON Co., Ltd.) [39]; (F) OMOM Capsule Endoscopy platform by Jinshan Science & Technology (Group) Co., Ltd. (Chongqing, China;courtesy of Jinshan Science & Technology (Group) Co., Ltd.) [40]; (G) Standing-type magnetically controlled capsule endoscopy system by JIFU Medical Technologies Co., Ltd. (Shenzhen, China) [41].

Figure 2

Research (non-commercialized) robotic gastroscopes: HydroJet-like gastroscopes developed by (A) Caprara et al. [47], (B) Campisano et al. [48], and (C) Yin et al. [49]; (D) Pneumatic gastroscope developed by Garbin et al. [50]; (E) Cable driven gastroscope developed by Ye et al. [51]; (F) Gastroscope modified by Swain et al. [52]; Self-driven gastroscopes developed by (G) Tortora et al. [53], and (H) De Falco et al. [54]; (I) Magnetic steering devices developed cooperatively by Olympus Corp. (Tokyo, Japan) and Siemens Healthcare GmbH (Erlangen, Germany) [55].

Figure 3

Novel flexible robots: (A) EndoMaster’s robotic system (EndoMaster Pte, Singapore) [67]; (B) ENDOSAMURAI^TM Olympus Medical Systems Corp. (Tokyo, Japan) [69]; (C) i²Snake robot [70,71]; (D) Flex^® Robotic System (Medrobotics Corp., Raynham, MA, USA; courtesy of Medrobotics Corp.) [72].

Figure 4

Remote health consultation (created with BioRender [110]).