title: Feasibility of automated target centralization in colonoscopy.
abstract: OBJECTIVE
  Early detection of colorectal cancer is key to full recovery. This urged governments to start population screening programs for colorectal cancer, often using flexible endoscopes. Flexible endoscopy is difficult to learn and time-consuming. Automation of flexible endoscopes may increase the capacity for the screening programs. The goal of this pilot study is to investigate the clinical and technical feasibility of an assisting automated navigation algorithm for a colonoscopy procedure.
  
  
  METHODS
  Automated navigation (lumen centralization) was implemented in a robotized system designed for conventional flexible endoscopes. Ten novice and eight expert users were asked to perform a diagnostic colonoscopy on a colon model twice: once using the conventional and once using the robotic system. Feasibility was evaluated using time and location data as measures of the system's added value.
  
  
  RESULTS
  Automated target centralization (ATC) was turned on by the novices for a median of 4.2% of the time during insertion and 0.3% during retraction. Experts turned ATC on for 4.0% of the time during insertion and 11.6% during retraction. Novices and experts showed comparable times to reach the cecum with the conventional or the robotic setup with ATC.
  
  
  CONCLUSIONS
  The ATC algorithm combined with the robotized endoscope setup works in an experimental setup that closely resembles the clinical environment and is considered feasible, although ATC use was lower than expected. For novices, it was unclear whether the low usage was due to unfamiliarity with the system or because they did not need ATC. Experts used ATC also during the retraction phase of the procedure. This was an unexpected finding and may indicate an added value of the system.
authors.affiliation: Department of Robotics and Mechatronics, MIRA Institute, University of Twente, Carré 3.625, P. O. Box 1502, 7500 AE, Enschede, The Netherlands. n.stap@utwente.nl.
authors.forename: N
authors.initials: N
authors.lastname: van der Stap
authors.affiliation: Department of Robotics and Mechatronics, MIRA Institute, University of Twente, Carré 3.625, P. O. Box 1502, 7500 AE, Enschede, The Netherlands.
authors.forename: E D
authors.initials: ED
authors.lastname: Rozeboom
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: H J M
authors.initials: HJ
authors.lastname: Pullens
authors.affiliation: Department of Robotics and Mechatronics, MIRA Institute, University of Twente, Carré 3.625, P. O. Box 1502, 7500 AE, Enschede, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van der Heijden
authors.affiliation: Department of Robotics and Mechatronics, MIRA Institute, University of Twente, Carré 3.625, P. O. Box 1502, 7500 AE, Enschede, The Netherlands.|Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: I A M J
authors.initials: IA
authors.lastname: Broeders
mesh_terms: D000465:Algorithms; D002983:Clinical Competence; D003113:Colonoscopy / Q000295:instrumentation* / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004867:Equipment Design; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods; D010865:Pilot Projects; D065287:Robotic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods
keywords: Automated endoscopy; Colonoscopic interventions; Image-based endoscope navigation; Robotized endoscopy