title: Joystick interfaces are not suitable for robotized endoscope applied to NOTES.
abstract: 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.
authors: IRCAD-EITS Institute, Strasbourg, France.
authors: Pierre
authors: P
authors: Allemann
authors: Laurent
authors: L
authors: Ott
authors: Mitsuhiro
authors: M
authors: Asakuma
authors: Norbert
authors: N
authors: Masson
authors: Silvana
authors: S
authors: Perretta
authors: Bernard
authors: B
authors: Dallemagne
authors: Dimitri
authors: D
authors: Coumaros
authors: Michel
authors: M
authors: De Mathelin
authors: Luc
authors: L
authors: Soler
authors: Jacques
authors: J
authors: Marescaux
mesh_terms: 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