Joystick interfaces are not suitable for robotized endoscope applied to NOTES.
BACKGROUND
NOTES has changed the working environment of endoscopy, leading to new difficulties. The limitations of conventional endoscopes call for the development of new platforms. Robotics may be the answer.


METHODS
The authors compared human to robotized manipulation of a flexible endoscope into the abdominal cavity, in an animal model. Thirty-two participants were enrolled. Results were analyzed according to the clinical background of the participants: experienced endoscopists, experienced laparoscopists, and medical students. Two single-channel gastroscopes were used. Whereas one was not modified, the other had the handling wheels replaced by motors controlled through a computer and a joystick. A NOTES transgastric approach was used to access the peritoneal cavity. The time to touch previously positioned intra-abdominal numbered plastic targets was recorded 3 times with each endoscope.


RESULTS
Mean time to complete the tasks was significantly shorter using the conventional endoscope (2.71 vs 6.96 minutes, P < .001). When the robotized endoscope was used, the mean times of endoscopists (7.42 minutes), laparoscopists (6.84 minutes), and students (6.77 minutes) were statistically identical. No differences were found between laparoscopists and students in both techniques.


CONCLUSIONS
Applying robotics to a flexible endoscope fails to enhance ability to move into the abdominal cavity, partly because of the interface. To overcome the limitations of endoscope when performing complex NOTES tasks, robotics may be useful, especially to control the instruments and to stabilize the endoscope itself.


CONCLUSIONS
Robotized endoscope with joystick interface is not sufficient to enhance immediate intuitiveness of flexible endoscopy applied to NOTES.
Allemann
Pierre
P
IRCAD-EITS Institute, Strasbourg, France.
Ott
Laurent
L
Asakuma
Mitsuhiro
M
Masson
Norbert
N
Perretta
Silvana
S
Dallemagne
Bernard
B
Coumaros
Dimitri
D
De Mathelin
Michel
M
Soler
Luc
L
Marescaux
Jacques
J
D000818:Animals; D002983:Clinical Competence; D004867:Equipment Design; D020699:Gastroscopes; D005773:Gastroscopy; D006801:Humans; D012371:Robotics; D013552:Swine; D013647:Task Performance and Analysis; D014584:User-Computer Interface