Interventional Status Awareness Based Manipulating Strategy for Robotic Soft Endoscopy

Traditional soft endoscopy is operated with naked eyes and use of hands. Robotic soft endoscopy frees the hands of endoscopists, which reduces the labor-intensity and complexity of operation and improves the operational accuracy of endoscope, but it’s hardly to be reliably performed because the operator lacks of situational awareness of endoscopic interventional status when the hands are detached from the endoscope. This paper first presents a method to perceive the interventional status of endoscope based on image processing, the interventional status includes insertion length and velocity. A manipulating strategy was designed according to the perceived endoscope interventional status and construction parameters of dual robotic arms in order to achieve reliable interventional endoscopy. Human phantom experiments are carried out to verify the effectiveness and feasibility of the proposed interventional status awareness method and manipulating strategy. The results show that the robotic soft endoscopy can be well performed with the ability of interventional status awareness and coordinated manipulation of dual arms. The perceived insertion length indicates the position of the tip of endoscope in human body and the designed manipulating strategy is effective in endoscopic shape retention and torque transmission.

Risk of appendicitis after endoscopic full-thickness resection of lesions involving the appendiceal orifice: a retrospective analysis

Background Conventional endoscopic resection of lesions affecting the appendiceal orifice is difficult. Endoscopic full-thickness resection (EFTR) is a novel technique in interventional endoscopy. As EFTR near the appendiceal orifice is associated with a subtotal appendectomy, it remains unclear whether the risk of developing appendicitis is increased. We conducted a retrospective analysis of lesions involving the appendiceal orifice treated by EFTR. Methods This was a multicenter retrospective analysis of patients (n = 50) treated with EFTR for lesions involving the appendiceal orifice between 2014 and 2019. The objective was to evaluate the occurrence of appendicitis. Results Acute appendicitis occurred in seven patients (14 %) during follow-up. Conservative treatment was sufficient in four cases, and three patients underwent appendectomy. Conclusions EFTR of lesions involving the appendiceal orifice may be associated with an imminent risk of developing appendicitis and a consecutive need for appendectomy. Patients should be informed about this specific risk prior to resection. It is unclear why some patients develop appendicitis while the majority remains asymptomatic.