Benjamin Colvard, MD1, Albert Serra-Torrent, MS1, Sophie Pernot, PhD1, Lee Swanstrom, MD1, Jacques Marescaux, MD2. 1IHU-Strasbourg, Institute of Image-Guided Surgery, 2IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France
Flexible endoscopy has traditionally been primarily a diagnostic field, and as such flexible endoscopes are designed for diagnostic procedures with minimal intervention such as biopsy or polypectomy. The benefit of natural orifice access to gastrointestinal pathologies has motivated practitioners to shift towards performing more complex interventional procedures such as endoscopic mucosal resection, endoscopic submucosal dissection, and in some cases, natural orifice transluminal endoscopic surgery. Despite advances in the flexible tools as well as the skill of operators, the field remains limited by the design of the flexible endoscope which often requires both hands to maintain target visualization (one hand controlling the wheels, one hand stabilizing the shaft). Shifting the right hand from the shaft to the instrument to change its position results in loss of target anatomy, increased time to perform an intervention, poor operator ergonomy and increased operator stress. We developed a low-cost plug-and-play accessory to the flexible endoscope to allow the operator to minimize right-hand shifts, thereby improving the stability of the endoscope during an interventional procedure. The FastTrack (FT) device is comprised of three components. The instrument driving component attaches to the working channel of any commercially available diagnostic flexible endoscope (Figure 1). The controls are attached to the handle of the endoscope, and the power box is placed on the endoscopic tower. Attachment takes less than 30 seconds, creating minimal disruption to the workflow. Once in place, the operator can perform fine adjustment of the instrument position using the left hand, keeping the right hand free to stabilize and torque the shaft of the endoscope (Figure 2). In a survey of 40 experienced flexible endoscopists, 63% felt they had improved stability with the FT, 72% reported improved overall comfort, and 85% thought that instrument manipulation was easier with FT than the conventional method (using the right hand). Additionally, among 14 participants who performed peg-transfer and target puncturing in an endoscopic training box, FT resulted in 38% time reduction for peg transfer, and 20% time reduction for target puncture (both NS). Future development will involve creating an improved, more robust prototype with more ergonomic left-hand controls. Additionally, an all-in-one device with integrated power, and drive mechanism is being developed and will be tested to determine the influence of increased weight compared to the benefit of a wireless system. We expect the device to greatly improve the comfort and precision of practitioners performing flexible endoscopic interventions.
Figure 1. The FastTrack concept
Figure 2. The FastTrack prototype. Note the user is able to control the insertion of the flexible instrument while maintaining their right hand on the shaft of the endoscope.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84254
Program Number: ETP743
Presentation Session: Emerging Technology Poster
Presentation Type: Poster