Future remedies
Dr. Gjorgi Deriban
Although there have been substantial advances in endoscopic imaging technology, the process of endoscope rotation and tip deflection has changed little since the development of flexible endoscopy. A freshman engineering student tasked with designing a device to navigate, examine, and provide therapy in the human colon likely would create a device that does not resemble the scope that we use daily to accomplish the task. Numerous investigators currently are working on novel devices designed to examine and deliver therapy to the digestive tract. These devices may diminish an endoscopist’s injury risk through the use of better ergonomic principles. This section is not intended to be a comprehensive review and is not an endorsement of any particular product. Rather, we hope it provides a glimpse into a possible future.
Reducing gravitational load
Dr. Patrick Young
The concept of a mechanical device to hold some or all of the weight of the endoscope was first published in 197413. Since then, a number of products have been described for this purpose.14-17 In general, these consist of a simple metal tube with a hemicylindrical plastic clip, similar to a microphone stand, or a yoke/strap with a plastic scope holder in the front akin to what a percussionist in a marching band might wear. For a variety of reasons, including limited mobility and issues with disinfection, these devices have not gained traction.
Novel control mechanisms
Some of the largest forces on the endoscopist relate to moving the wheels on the scope head to effect tip deflection via a cable linkage. Because the wheels rotate only in one axis, the options for altering and adjusting load are few. One proposed solution is the use of a system with a fully detachable endoscope handle with a joystick style control deck (E210; Invendo Medical, Kissing, Germany). The control deck uses electromechanical assistance — as opposed to pure mechanical force — to transmit energy to the shaft of the instrument. Such assistive technologies have the potential to decrease injuries by decreased load, particularly on the carpometacarpal joint. Other devices seek to decrease the need for torque and high-load tip deflection though the use of self-propelled, disposable colonoscopes that use an aviation-style joystick (Aer-o-scope; GI View, Kissing, Germany). Although interesting and potentially useful, neither product is currently available for clinical use in the United States.
Robots and magnets
Magnetically controlled wireless capsules have been studied in vivo in human beings on several occasions in the United Kingdom and Asia. Wired colonic capsules are currently under development in the United States. These products use joystick-style controls to direct movement of the capsule. Optimal visualization often requires the patient to rotate through numerous positions and, at least in the stomach, to drink significant quantities of fluid to ensure adequate distention. At present, these devices provide only diagnostic capabilities.
Conclusions
The performance of endoscopy inherently places its practitioners at risk of biomechanical injury. Fortunately, there are numerous ways we can optimize our environment and ourselves. We should treat our bodies as professional athletes do: use good form, encourage colleagues to observe and provide feedback on our actions, optimize our practice facilities, and stretch our muscles. In the future, technological innovations, such as ergonomically designed endoscope handles and self-propelled colonoscopies, may reduce the inherent physical stresses of endoscopy. In doing so, hopefully we can preserve our own health and continue to better the health of our patients as well.
