Abstract
Flexible endoscopy involves the insertion of a long narrow flexible tube into the body for diagnostic and therapeutic procedures. In the gastrointestinal (GI) tract, flexible endoscopy plays a major role in cancer screening, surveillance, and treatment programs. As a result of gas insufflation during the procedure, both upper and lower GI endoscopy procedures have been classified as aerosol generating by the guidelines issued by the respective societies during the COVID-19 pandemic—although no quantifiable data on aerosol generation currently exists. Due to the risk of COVID-19 transmission to healthcare workers, most societies halted non-emergency and diagnostic procedures during the lockdown. The long-term implications of stoppage in cancer diagnoses and treatment is predicted to lead to a large increase in preventable deaths. Robotics may play a major role in this field by allowing healthcare operators to control the flexible endoscope from a safe distance and pave a path for protecting healthcare workers through minimizing the risk of virus transmission without reducing diagnostic and therapeutic capacities. This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic. The authors propose that a few minor changes to existing platforms or considerations for platforms in development could lead to significant benefits for use during infection control scenarios.
Highlights
Onaizah Onaizah 1*, Zaneta Koszowska 1, Conchubhair Winters 2, Venkatamaran Subramanian 2, David Jayne 2, Alberto Arezzo 3, Keith L
This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic
We explore the impact of COVID19 on GI endoscopy processes and how robotic flexible endoscopic platforms can be designed to minimize these impacts and improve infection control (IC) mechanisms
Summary
Endoscopy is a procedure where organs and tissues inside the body can be imaged and monitored using an endoscope. In 2014, it was projected that there will be over 75 million gastrointestinal endoscopic procedures performed by 2020 in Europe and the United States alone (Lau, 2014). One of the postulated sources of aerosol generation during endoscopy procedures is related to gas insufflation. Evidence of aerosols generated during different endoscopic procedures varies and there is no homogeneity of evidence. For GI endoscopic procedures, no current evidence exists of aerosol generation and advice from respective societies around infection control (IC) is based on expert opinion (Chai et al, 2020; Mahadev et al, 2020; Repici et al, 2020; Tse et al, 2020). PPE has been enhanced during the COVID-19 pandemic to include a full sleeve
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