Abstract

When detected early, colorectal cancer can be treated with minimally invasive flexible endoscopy. However, since only specialized experts can delineate margins and perform endoscopic resections of lesions, patients still often undergo colon resections. To better assist in the performance of surgical tasks, a robotized flexible interventional endoscope was previously developed, having two additional side channels for surgical instrument. We propose to enhance the imaging capabilities of this device by combining it with optical coherence tomography (OCT). For this purpose, we have developed a new steerable OCT instrument with an outer diameter of 3.5 mm. The steerable instrument is terminated with a 2 cm long transparent sheath to allow three-dimensional OCT imaging using a side-focusing optical probe with two external scanning actuators. The instrument is connected to an OCT imaging system built around the OCT Axsun engine, with a 1310 nm center wavelength swept source laser and 100 kHz A-line rate. Once inserted in one of the side channels of the robotized endoscope, bending, rotation and translation of the steerable OCT instrument can be controlled by a physician using a joystick. Ex vivo and in vivo tests show that the novel, steerable and teleoperated OCT device enhances dexterity, allowing for inspection of the surgical field without the need for changing the position of the main endoscope.

© 2020 Optical Society of America under the terms of the OSA Open Access Publishing Agreement

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References

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2019 (3)

I. J. M. Levink, H. C. Wolfsen, P. D. Siersema, M. B. Wallace, and G. J. Tearney, “Measuring Barrett’s Epithelial Thickness with Volumetric Laser Endomicroscopy as a Biomarker to Guide Treatment,” Dig. Dis. Sci. 64(6), 1579–1587 (2019).
[Crossref]

O. O. Ahsen, K. Liang, H.-C. Lee, Z. Wang, J. G. Fujimoto, and H. Mashimo, “Assessment of chronic radiation proctopathy and radiofrequency ablation treatment follow-up with optical coherence tomography angiography: A pilot study,” World J. Gastroenterol. 25(16), 1997–2009 (2019).
[Crossref]

W. C. Y. Lo, N. Uribe-Patarroyo, K. Hoebel, K. Beaudette, M. Villiger, N. S. Nishioka, B. J. Vakoc, and B. E. Bouma, “Balloon catheter-based radiofrequency ablation monitoring in porcine esophagus using optical coherence tomography,” Biomed. Opt. Express 10(4), 2067 (2019).
[Crossref]

2018 (5)

X. Zhao, X. Fu, C. Blumenthal, Y. T. Wang, M. W. Jenkins, C. Snyder, M. Arruda, and A. M. Rollins, “Integrated RFA/PSOCT catheter for real-time guidance of cardiac radio-frequency ablation,” Biomed. Opt. Express 9(12), 6400 (2018).
[Crossref]

L. Zorn, F. Nageotte, P. Zanne, A. Legner, B. Dallemagne, J. Marescaux, and M. De Mathelin, “A Novel Telemanipulated Robotic Assistant for Surgical Endoscopy: Preclinical Application to ESD,” IEEE Trans. Biomed. Eng. 65(4), 797–808 (2018).
[Crossref]

T. Couture and J. Szewczyk, “Design and experimental validation of an active catheter for endovascular navigation,” J. Med. Devices, Trans. ASME 12(1), 011003 (2018).
[Crossref]

A. J. Trindade, P. C. Benias, S. Inamdar, C. Fan, A. Sethi, N. Fukami, A. Kahn, M. Kahaleh, I. Andalib, D. V. Sejpal, and A. Rishi, “Use of volumetric laser endomicroscopy for determining candidates for endoscopic therapy in superficial esophageal squamous cell carcinoma,” United Eur. Gastroenterol. J. 6(6), 838–845 (2018).
[Crossref]

T. Matsuda, K. Yamashita, H. Hasegawa, T. Oshikiri, M. Hosono, N. Higashino, M. Yamamoto, Y. Matsuda, S. Kanaji, T. Nakamura, S. Suzuki, Y. Sumi, and Y. Kakeji, “Recent updates in the surgical treatment of colorectal cancer,” Ann. Gastroenterol. Surg. 2(2), 129–136 (2018).
[Crossref]

2017 (3)

2016 (3)

J. East, J. Vleugels, P. Roelandt, P. Bhandari, R. Bisschops, E. Dekker, C. Hassan, G. Horgan, R. Kiesslich, G. Longcroft-Wheaton, A. Wilson, and J.-M. Dumonceau, “Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review,” Endoscopy 48(11), 1029–1045 (2016).
[Crossref]

S. Roy and C. Evans, “Overview of robotic colorectal surgery: Current and future practical developments,” World J. Gastrointest. Surg. 8(2), 143 (2016).
[Crossref]

B. P. M. Yeung and P. W. Y. Chiu, “Application of robotics in gastrointestinal endoscopy: A review,” World J. Gastroenterol. 22(5), 1811–1825 (2016).
[Crossref]

2015 (4)

2014 (4)

O. O. Ahsen, H.-C. Lee, M. G. Giacomelli, Z. Wang, K. Liang, T.-H. Tsai, B. Potsaid, H. Mashimo, and J. G. Fujimoto, “Correction of rotational distortion for catheter-based en face OCT and OCT angiography,” Opt. Lett. 39(20), 5973 (2014).
[Crossref]

C. L. Leggett and E. C. Gorospe, “Application of confocal laser endomicroscopy in the diagnosis and management of Barrett’s esophagus,” Ann. Gastroenterol. 27(3), 193–199 (2014).

C. L. Leggett, E. Gorospe, V. L. Owens, M. Anderson, L. Lutzke, and K. K. Wang, “Volumetric Laser Endomicroscopy Detects Subsquamous Barrett's Adenocarcinoma,” Am. J. Gastroenterol. 109(2), 298–299 (2014).
[Crossref]

A. M. D. Lee, H. Pahlevaninezhad, V. X. D. Yang, S. Lam, C. MacAulay, and P. Lane, “Fiber-optic polarization diversity detection for rotary probe optical coherence tomography,” Opt. Lett. 39(12), 3638–3641 (2014).
[Crossref]

2013 (2)

T. Kaltenbach and R. Soetikno, “Endoscopic Resection of Large Colon Polyps,” Gastrointest. Endosc. Clin. N. Am. 23(1), 137–152 (2013).
[Crossref]

M. J. Gora, J. S. Sauk, R. W. Carruth, K. A. Gallagher, M. J. Suter, N. S. Nishioka, L. E. Kava, M. Rosenberg, B. E. Bouma, and G. J. Tearney, “Tethered capsule endomicroscopy enables less invasive imaging of gastrointestinal tract microstructure,” Nat. Med. 19(2), 238–240 (2013).
[Crossref]

2011 (1)

H. Wang, W. Kang, T. Carrigan, A. Bishop, N. Rosenthal, M. Arruda, and A. M. Rollins, “In vivo intracardiac optical coherence tomography imaging through percutaneous access: toward image-guided radio-frequency ablation,” J. Biomed. Opt. 16(11), 110505 (2011).
[Crossref]

2010 (4)

C. P. Fleming, K. J. Quan, and A. M. Rollins, “Toward guidance of epicardial cardiac radiofrequency ablation therapy using optical coherence tomography,” J. Biomed. Opt. 15(4), 041510 (2010).
[Crossref]

P. E. Dupont, J. Lock, B. Itkowitz, and E. Butler, “Design and control of concentric-tube robots,” IEEE Trans. Robot. 26(2), 209–225 (2010).
[Crossref]

B. Dallemagne and J. Marescaux, “The ANUBISTM project,” Minim. Invasive Ther. Allied Technol. 19(5), 257–261 (2010).
[Crossref]

M. J. Suter, P. A. Jillella, B. J. Vakoc, E. F. Halpern, M. Mino-Kenudson, G. Y. Lauwers, B. E. Bouma, N. S. Nishioka, and G. J. Tearney, “Image-guided biopsy in the esophagus through comprehensive optical frequency domain imaging and laser marking: a study in living swine,” Gastrointest. Endosc. 71(2), 346–353 (2010).
[Crossref]

2009 (2)

2008 (1)

G. van Soest, J. G. Bosch, and A. F. W. van der Steen, “Azimuthal Registration of Image Sequences Affected by Nonuniform Rotation Distortion,” IEEE Trans. Inf. Technol. Biomed. 12(3), 348–355 (2008).
[Crossref]

2007 (1)

Y. Kawase, Y. Suzuki, F. Ikeno, R. Yoneyama, K. Hoshino, H. Q. Ly, G. T. Lau, M. Hayase, A. C. Yeung, R. J. Hajjar, and I.-K. Jang, “Comparison of nonuniform rotational distortion between mechanical IVUS and OCT using a phantom model,” Ultrasound Med. Biol. 33(1), 67–73 (2007).
[Crossref]

2006 (1)

S. Oka, S. Tanaka, I. Kaneko, R. Mouri, M. Hirata, T. Kawamura, M. Yoshihara, and K. Chayama, “Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer,” Gastrointest. Endosc. 64(6), 877–883 (2006).
[Crossref]

2005 (1)

V. R. Patel, A. S. Tully, R. Holmes, and J. Lindsay, “Robotic radical prostatectomy in the community setting - The learning curve and beyond: Initial 200 cases,” J. Urol. 174(1), 269–272 (2005).
[Crossref]

2003 (1)

Participants in the Paris Workshop, “The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002,” Gastrointest. Endosc. 58(6), S3–S43 (2003).
[Crossref]

1997 (1)

1996 (1)

A. Della Santa, A. Mazzoldi, and D. De Rossi, “Steerable microcatheters actuated by embedded conducting polymer structures,” J. Intell. Mater. Syst. Struct. 7(3), 292–300 (1996).
[Crossref]

1995 (1)

S. Guo, T. Fukuda, K. Kosuge, F. Arai, K. Oguro, and M. Negoro, “Micro catheter system with active guide wire,” Proceedings - IEEE International Conference on Robotics and Automation 1, 79–84 (1995).
[Crossref]

Abdelal, H.

Y. Zeng, S. Xu, W. C. C. Jr, S. Li, Z. Alipour, H. Abdelal, D. Chatterjee, M. Mutch, and Q. Zhu, “Real-time colorectal cancer diagnosis using PR-OCT with deep learning,” Theranostics (2019).

Adler, D. C.

Ahsen, O. O.

O. O. Ahsen, K. Liang, H.-C. Lee, Z. Wang, J. G. Fujimoto, and H. Mashimo, “Assessment of chronic radiation proctopathy and radiofrequency ablation treatment follow-up with optical coherence tomography angiography: A pilot study,” World J. Gastroenterol. 25(16), 1997–2009 (2019).
[Crossref]

O. O. Ahsen, H.-C. Lee, M. G. Giacomelli, Z. Wang, K. Liang, T.-H. Tsai, B. Potsaid, H. Mashimo, and J. G. Fujimoto, “Correction of rotational distortion for catheter-based en face OCT and OCT angiography,” Opt. Lett. 39(20), 5973 (2014).
[Crossref]

Ajioka, Y.

S. Tanaka, H. Kashida, Y. Saito, N. Yahagi, H. Yamano, S. Saito, T. Hisabe, T. Yao, M. Watanabe, M. Yoshida, S. Kudo, O. Tsuruta, K. Sugihara, T. Watanabe, Y. Saitoh, M. Igarashi, T. Toyonaga, Y. Ajioka, M. Ichinose, T. Matsui, A. Sugita, K. Sugano, K. Fujimoto, and H. Tajiri, “JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection,” Dig. Endosc. 27(4), 417–434 (2015).
[Crossref]

Akahori, H.

Y. Haga, Y. Muyari, T. Mineta, T. Matsunaga, H. Akahori, and M. Esashi, “Small diameter hydraulic active bending catheter using laser processed super elastic alloy and silicone rubber tube,” in 2005 3rd IEEE/EMBS Special Topic Conference on Microtechnology in Medicine and Biology (2005), 2005, pp. 245–248.

Alipour, Z.

Y. Zeng, S. Xu, W. C. C. Jr, S. Li, Z. Alipour, H. Abdelal, D. Chatterjee, M. Mutch, and Q. Zhu, “Real-time colorectal cancer diagnosis using PR-OCT with deep learning,” Theranostics (2019).

Andalib, I.

A. J. Trindade, P. C. Benias, S. Inamdar, C. Fan, A. Sethi, N. Fukami, A. Kahn, M. Kahaleh, I. Andalib, D. V. Sejpal, and A. Rishi, “Use of volumetric laser endomicroscopy for determining candidates for endoscopic therapy in superficial esophageal squamous cell carcinoma,” United Eur. Gastroenterol. J. 6(6), 838–845 (2018).
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Am. J. Gastroenterol. (1)

C. L. Leggett, E. Gorospe, V. L. Owens, M. Anderson, L. Lutzke, and K. K. Wang, “Volumetric Laser Endomicroscopy Detects Subsquamous Barrett's Adenocarcinoma,” Am. J. Gastroenterol. 109(2), 298–299 (2014).
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Ann. Gastroenterol. (1)

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Ann. Gastroenterol. Surg. (1)

T. Matsuda, K. Yamashita, H. Hasegawa, T. Oshikiri, M. Hosono, N. Higashino, M. Yamamoto, Y. Matsuda, S. Kanaji, T. Nakamura, S. Suzuki, Y. Sumi, and Y. Kakeji, “Recent updates in the surgical treatment of colorectal cancer,” Ann. Gastroenterol. Surg. 2(2), 129–136 (2018).
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Biomed. Opt. Express (7)

D. Herranz, J. Lloret, S. Jiménez-Valero, J. L. Rubio-Guivernau, and E. Margallo-Balbás, “Novel catheter enabling simultaneous radiofrequency ablation and optical coherence reflectometry,” Biomed. Opt. Express 6(9), 3268 (2015).
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T. Wang, T. Pfeiffer, E. Regar, W. Wieser, H. van Beusekom, C. T. Lancee, G. Springeling, I. Krabbendam, A. F. W. van der Steen, R. Huber, and G. van Soest, “Heartbeat OCT: in vivo intravascular megahertz-optical coherence tomography,” Biomed. Opt. Express 6(12), 5021–5032 (2015).
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M. Keenan, T. H. Tate, K. Kieu, J. F. Black, U. Utzinger, and J. K. Barton, “Design and characterization of a combined OCT and wide field imaging falloposcope for ovarian cancer detection,” Biomed. Opt. Express 8(1), 124 (2017).
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O. M. Carrasco-Zevallos, C. Viehland, B. Keller, M. Draelos, A. N. Kuo, C. A. Toth, and J. A. Izatt, “Review of intraoperative optical coherence tomography: technology and applications [Invited],” Biomed. Opt. Express 8(3), 1607 (2017).
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M. J. Gora, M. J. Suter, G. J. Tearney, and X. Li, “Endoscopic optical coherence tomography: technologies and clinical applications [Invited],” Biomed. Opt. Express 8(5), 2405 (2017).
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Figures (8)

Fig. 1.
Fig. 1. Schematic drawing and picture of the OCT steerable catheter connected to the OCT system (OCT) via volumetric scanning actuator (RJ) together with detailed schemes of instrument driver module (IM) with flexion actuator (FA) and distal bendable section of the catheter.
Fig. 2.
Fig. 2. (A) Schematic drawing of the robotized flexible interventional endoscope with the steerable OCT catheter attached to a slave cart that is connected to user controllers for teleoperation of the device: instrument actuators (IM1, IM2), pullback scanning actuation (RJ), OCT system (OCT), endoscope processor (Endo P), endoscope light source (Endo LS). (B) Front view of the distal end of the robotized flexible interventional endoscope with steerable OCT catheter.
Fig. 3.
Fig. 3. Schematic drawing of transmission of motions from master controller (on the left) in teleoperation mode to the distal tip of the steerable OCT catheter that enables its rotation, translation and flexion (slave unit on the right).
Fig. 4.
Fig. 4. (A) Theoretical geometry of a rectangular tube used to measure the rotational distortion where QA, QB, QC, and QD are the angles to measure. (B) Picture of an actual 3D printed target with visible roughness on shorter sides and residues of a support material in the lumen. (C) OCT probe inserted into the rectangular target.
Fig. 5.
Fig. 5. (A) Steerable tool placed in the position of 74° of angle of flexion. (B) Rotational distortion versus angle of flexion for the frame rates of 16.67, 33.33, 83.33 and 125 fps. Exemplary OCT cross-sections obtained with the steerable OCT catheter showing (C) very high NURD at 17 fps and (D) very low NURD at 125 fps. Yellow arrows point to areas with lower intensity in OCT cross-sections most likely caused by 3D printing material discontinuities and residues of a support material in the inner lumen injected during 3D printing process of a hollow target that caused shadowing of the OCT light.
Fig. 6.
Fig. 6. (A) Rotational distortion versus frame rate for every selected angle of flexion. (B) Distortions of the steerable catheter averaged for all selected angles and distortions of the regular catheter versus frame rate.
Fig. 7.
Fig. 7. (A) Colon model (LM107C) with inserted robotized endoscope. Teleoperated steerable OCT device and biopsy forceps can be seen in white light endoscopy during examination of the pedunculated phantom polyp base (B) and back (C), and over a sessile phantom polyp (D).
Fig. 8.
Fig. 8. Results obtained during experiments in the swine bowel in vivo. (A, C) Screenshots from the white light endoscopic camera of the robotized endoscope showing a cautery tool and the steerable OCT catheter in two position. (B, D) Corresponding OCT cross-sections with layered bowel architecture comprising mucosa (M), submucosa (SM) and muscle (ML) visible in zoomed areas. (E) Screenshots from the white light endoscopic camera showing insertion of the needle using the endoscope’s working channel. (F) Corresponding OCT cross-section with visible reflection from the cautery tool (CT) that was just above the OCT catheter in (E). (G) Needle injection of methylene blue to elevate submucosa. (H) Corresponding OCT cross-section showing mucosa and submucosa layer, followed by the methylene blue clear to near-infrared radiation and strong reflection from the needle (N). In the center of all OCT cross-sections plastic transparent sheath is visible as two concentric rings (S).