A UK single-center pilot experience using a novel robotic inchworm colonoscopy system

Abstract

Introduction: Colonoscopy is the gold standard investigation in the lower gastrointestinal tract. However, 75% of patients can experience pain with moderate sedation. The application of robotic technology aims to overcome difficulties faced including better utilization of rooms for advanced procedures and to achieve a complete colonoscopy in patients restricted by pain and technical challenges. Methods: This pilot study, the first at a UK-National Health Service Hospital between January 2023 to August 2024 with one expert endoscopist performing the robotic colonoscopy (RC). Patients with failed previous standard colonoscopy (SC) along with index diagnostic procedures deemed potentially difficult were recruited. Procedures were performed outside the endoscopy unit similar to an outpatient clinical room. Results: Ninety-three patients were recruited (41 men:52 women), mean age of 53.8 years over 20 months. The commonest indications for RC were rectal bleeding (26.9%), failed SC (22.6%), and change in bowel habits (17.2%). Twenty-one patients had failed the previous SC with 14 patients achieving completion with subsequent RC (66% improvement). The average cecal intubation time of 41.07 min with an average total procedure time of 76.48 min. A significant improvement in patient discomfort score was reported (4.71 SC vs. 1.71 RC; p < 0.001). Conclusions: RC provides a significantly more comfortable colonoscopy and has great potential to improve safety in colonoscopy from this early cohort of patients. Direct visualization, biopsy, and polypectomy are still possible with RC. This study has demonstrated a viable alternative to SC. With no sedation it allows procedures to be conducted outside the traditional endoscopy unit such as outpatients. The study highlights a learning curve to reduce cecal intubation time.