Colorectal cancer (CRC) is a serious disease, has the third most prevalent cancer incidence and is second for cancer-related deaths, with almost 1 million deaths per year. Most of these CRCs develop from colonic polyps, which can be present for years before the development of the CRC. Their detection is therefore critical.
colonoscopy allows both the identification and removal of colonic polyps during a single procedure
It is estimated that the removal of polyps is associated with a 60% reduction in CRC- related deaths. In this regard, colonoscopy allows both the identification and removal of colonic polyps during a single procedure.
Combined diagnosis and treatment
Lower gastrointestinal endoscopy is considered the gold standard for the diagnosis and removal of colonic polyps. If there is any delay in colonoscopy following a positive stool test this will increase the likelihood of advanced CRC occurrence. However, patients may refuse to undergo conventional colonoscopy (CC) due to fear of possible risks and pain or discomfort. In this regard, patients undergoing CC frequently require sedation to better tolerate the procedure, increasing the risk of deep sedation or other complications related to sedation. Accordingly, the use of CC as a first-line screening strategy for CRC is hampered by patients’ reluctance due to its invasiveness and anxiety about possible discomfort.
To overcome these limitations, researchers and investigators, including Dr Premchand in the UK, have investigated the use of robotic colonoscopy (RC). Self-propelling robotic colonoscopes are highly flexible and adapt to the shape of the lower gastrointestinal tract, allowing a virtually painless examination of the colon. The first painless robotic colonoscopy clinic went live in UK in May 2023.
Aternative procedures to CC and RC include:
- barium enema (BE),
- computed tomographic colonography (CTC), and
- colon capsule endoscopy (CCE).
However, these are purely diagnostic procedures and are limited by the need for subsequent investigations whenever suspicious lesions are found. Therefore a follow-up treatment procedure will also be required following CTC and CCE.
A colonic robot designed by nature
RC systems clearly mark a major advance in endoscopy. The new endoscopes are painless as they use a method of locomotion to adapt to the shape of the lower gastrointestinal tract, which reduces pressure on the colonic walls. This also reduces any risk of perforation and removes the need for sedation.
Studies demonstrate that robotic colonoscopes can provide a far more comfortable alternative to standard colonoscopy. The only RC system that is currently available for use in clinical practice is the Endotics System that although now in use in other hospitals in Europe, has been pioneered in the UK by Consultant Gastroenterologist, Dr Prem Premchand at his NHS Trust hospital.
The pioneering and innovative robotic colonoscopy (RC) represents the future of quality medical care. Following the launch at the RBH Trust, this is not a service that is widely available across the UK yet – although it is likely to be so at some point in the near future.
RC is a massive step forward as this technology allows the following fundamental patient and hospital benefits:
- Painless, and so patients who could not otherwise tolerate the procedure can now be diagnosed and treated.
- No sedation means that recovery facilities and staff are not required.
- Disposable units – means no requirement for decontamination, radically reducing staff costs and removing need for expensive facilities.
- Patient safety, as the device does not require forceful pressure, risk of perforation is reduced.
- The procedure will become available on an OP basis.
Robotic Colonoscopy and Beyond: Insights into Modern Lower Gastrointestinal Endoscopy
Emanuele Tumino 1, Pierfrancesco Visaggi 1,2,* , Valeria Bolognesi 1, Linda Ceccarelli 2, Christian Lambiase 2,
Sergio Coda 3, Purushothaman Premchand 3, Massimo Bellini 2 , Nicola de Bortoli 2 and Emanuele Marciano 1