The milestone brings closer the prospect of an intelligent robotic system being able to guide instruments to precise locations in the body to take biopsies or allow internal tissues to be examined.

A doctor or nurse would still be on hand to make clinical decisions but the demanding task of manipulating the device is offloaded to a robotic system.

The latest findings — ‘Enabling the future of colonoscopy with intelligent and autonomous magnetic manipulation’ — is the culmination of 12 years of research by an international team of scientists led by the University of Leeds.

The research is published today (Monday, 12 October) in the scientific journal Nature Machine Intelligence. 

Patient trials using the system could begin next year or in early 2022.

Pietro Valdastri, Professor of Robotics and Autonomous Systems at Leeds, is supervising the research. He said: “Colonoscopy gives doctors a window into the world hidden deep inside the human body and it provides a vital role in the screening of diseases such as colorectal cancer. But the technology has remained relatively unchanged for decades.

“What we have developed is a system that is easier for doctors or nurses to operate and is less painful for patients. It marks an important a step in the move to make colonoscopy much more widely available — essential if colorectal cancer is to be identified early.”

Because the system is easier to use, the scientists hope this can increase the number of providers who can perform the procedure and allow for greater patient access to colonoscopy.

A colonoscopy is a procedure to examine the rectum and colon. Conventional colonoscopy is carried out using a semi-flexible tube which is inserted into the anus, a process some patients find so painful they require an anaesthetic.

Magnetic flexible colonoscope

The research team has developed a smaller, capsule-shaped device which is tethered to a narrow cable and is inserted into the anus and then guided into place — not by the doctor or nurse pushing the colonoscope but by a magnet on a robotic arm positioned over the patient.

The robotic arm moves around the patient as it manoeuvres the capsule. The system is based on the principle that magnetic forces attract and repel.

The magnet on the outside of the patient interacts with tiny magnets in the capsule inside the body, navigating it through the colon. The researchers say it will be less painful than having a conventional colonoscopy.

Guiding the robotic arm can be done manually but it is a technique that is difficult to master. In response, the researchers have developed different levels of robotic assistance. This latest research evaluated how effective the different levels of robotic assistance were in aiding non-specialist staff to carry out the procedure.

Levels of robotic assistance

Direct robot control. This is where the operator has direct control of the robot via a joystick. In this case, there is no assistance.

Intelligent endoscope teleoperation. The operator focuses on where they want the capsule to be located in the colon, leaving the robotic system to calculate the movements of the robotic arm necessary to get the capsule into place.

Semi-autonomous navigation. The robotic system autonomously navigates the capsule through the colon, using computer vision — although this can be overridden by the operator.

During a laboratory simulation, 10 non-expert staff were asked to get the capsule to a point within the colon within 20 minutes. They did that five times, using the three different levels of assistance.

Using direct robot control, the participants had a 58% success rate. That increased to 96% using intelligent endoscope teleoperation — and 100% using semi-autonomous navigation.

In the next stage of the experiment, two participants were asked to navigate a conventional colonoscope into the colon of two anaesthetised pigs — and then to repeat the task with the magnet-controlled robotic system using the different levels of assistance. A vet was in attendance to ensure the animals were not harmed.

The participants were scored on the NASA Task Load Index, a measure of how taxing a task was, both physically and mentally.

The NASA Task Load Index revealed that they found it easier to operate the colonoscope with robotic assistance. A sense of frustration was a major factor in operating the conventional colonoscope and where participants had direct control of the robot.

James Martin, a PhD researcher from the University of Leeds who co-led the study, said: “Operating the robotic arm is challenging. It is not very intuitive and that has put a brake on the development of magnetic flexible colonoscopes.

“But we have demonstrated for the first time that it is possible to offload that function to the robotic system, leaving the operator to think about the clinical task they are undertaking — and it is making a measurable difference in human performance.”

The techniques developed to conduct colonoscopy examinations could be applied to other endoscopic devices, such as those used to inspect the upper digestive tract or lungs.

Dr Bruno Scaglioni, a Postdoctoral Research Fellow at Leeds and co-leader of the study, added: “Robot-assisted colonoscopy has the potential to revolutionize the way the procedure is carried out. It means people conducting the examination do not need to be experts in manipulating the device.

“That will hopefully make the technique more widely available, where it could be offered in clinics and health centres rather than hospitals.”

The findings, published in the journal Proceedings of the National Academy of Sciences (PNAS), may provide a much-needed and affordable insecticide alternative in the face of growing resistance among mosquitoes.

“The use of more active crystal forms of insecticides is a simple and powerful strategy for improving commercially available compounds for malaria control, circumventing the need for developing new products in the ongoing fight against mosquito-borne diseases,” said Bart Kahr, professor of chemistry at NYU and one of the study’s senior authors.

“Improvements in malaria control are needed as urgently as ever during the global COVID-19 crisis,” added Kahr. “The number of deaths from malaria in Africa this year is projected to double as a result of coronavirus-related disruptions to supply chains. We need public health measures to curtail both infectious diseases, and for malaria, this includes more effective insecticides.”

Malaria is a major public health challenge worldwide, with more than 200 million cases and 400,000 deaths reported each year. Insecticides such as deltamethrin can prevent the spread of diseases carried by mosquitoes and are often sprayed indoors and on bed nets. However, mosquitoes are increasingly becoming resistant to insecticides, leaving researchers and public health officials searching for alternatives with new modes of action.

Many insecticides, including deltamethrin, are in the form of crystals — the research focus for Kahr and fellow NYU chemistry professor Michael Ward. When mosquitoes step on insecticide crystals, the insecticide is absorbed through their feet and, if effective, kills the mosquitoes.

As part of their research on crystal formation and growth, Kahr and Ward study and manipulate insecticide crystals, exploring their alternative forms. In their PNAS study, the researchers heated the commercially available form of deltamethrin to 110°C/230°F for a few minutes and let it cool to room temperature; this resulted in a new crystallized form of deltamethrin, composed of long, tiny fibers radiating from a single point.

When tested on Anopheles quadrimaculatus and Aedes aegypti mosquitoes — both of which transmit malaria — and fruit flies, the new crystal form of deltamethrin worked up to 12 times faster than the existing form. Fast-acting insecticides are important for quickly controlling mosquitoes before they reproduce or continue spreading diseases.

The new form also remained stable — and able to rapidly kill mosquitoes — for at least three months.

To simulate how the two forms of deltamethrin would perform in stemming the spread of malaria, the researchers turned to epidemiological modeling that suggests that using the new form in indoor spraying in place of the original form would significantly suppress malaria transmission, even in regions with high levels of insecticide resistance. Moreover, less of the new form would need to be used to achieve the same effect, potentially lowering the cost of mosquito control programs and reducing environmental exposure to the insecticide.

“Deltamethrin has been a leading tool in combating malaria, but it faces an uncertain future, threatened by developing insecticide resistance. The simple preparation of this new crystal form of deltamethrin, coupled with its stability and markedly greater efficacy, shows us that the new form can serve as a powerful and affordable tool for controlling malaria and other mosquito-borne diseases,” said Ward.

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Materials provided by New York University. Note: Content may be edited for style and length.

In response to this emerging need, researchers at the National Human Genome Research Institute (NHGRI), part of the National Institutes of Health, asked patients, parents and physicians in the sickle cell disease community what they wanted and needed to know about genome editing to make informed decisions about participating in genome-editing clinical trials. Gene-editing treatments, which appear to provide a potential for sickle cell, are among the most widely publicized medical advances in recent years. The results were published this week in the journal AJOB Empirical Bioethics.

“An important goal of informed consent is to facilitate decisions that are consistent with a person’s values,” said Sara Hull, Ph.D., director of the Bioethics Core at NHGRI. “By talking to sickle cell disease stakeholders ahead of time, we can learn more about their values and hopefully do a better job of pinpointing what kinds of information will be most useful to potential research participants as they make very a difficult decision.”

Researchers contacted adults with sickle cell disease and parents and physicians of adults and children with the disease. These participants completed a genetic literacy survey, watched an educational video about genome editing, completed a two-part survey, and took part in focus group discussions about CRISPR somatic genome editing, an experimental treatment option for sickle cell disease.

The researchers found that all participants wanted informed consent to include the treatment side effects of CRISPR somatic genome editing. Many people also wanted to know how such editing works and its impact on their quality of life. The groups reflected on the need to have flexibility in the kind of information provided since people have differing levels of knowledge of biology and genomics.

Interestingly, while some physicians were concerned about how well patients would understand concepts related to somatic genome editing, study participants demonstrated higher genetic literacy levels than estimated.

The NHGRI study suggests that the sickle cell disease community is optimistic about the promises of somatic genome editing. Responses highlight the need to begin discussing what informed consent looks like, especially when lack of information and misconceptions about the risks and benefits can influence a person’s decision to participate in a clinical trial.

“Designing clinical trials for curative genetic therapies requires addressing the patient communities and their families need for accessible information about the risks and benefits,” said Vence Bonham, J.D., an associate investigator in the Social and Behavioral Research Branch at NHGRI and senior author on the paper. “These first-in-human curative genome editing therapies are an opportunity to develop new consent approaches to meet the information needs of potential research study participants and their families.”

By creating a standard for informed consent with respect to genome editing clinical trials, such engagement with patient communities may be replicated across biotechnology companies and research institutions.

“Participating in any clinical trial is both a matter of faith and good judgment for individuals, and the research community must build models of consent, understanding and trust as crucial pillars that promote safety and success for the patients,” Bonham said.

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Materials provided by NIH/National Human Genome Research Institute. Original written by Prabarna Ganguly. Note: Content may be edited for style and length.