Researchers from Zurich have successfully performed remote magnetic endoscopy on a pig living in Hong Kong

Researchers from ETH Zurich and the Chinese University of Hong Kong have succeeded for the first time in performing remote magnetic endoscopy on a living pig. The researchers controlled the probe from Zurich while the animal was on the operating table in Hong Kong.

It’s three in the morning and Alexandre Mesot is in a room in Zurich operating on an endoscope. The doctoral student at ETH Zurich’s Multiscale Robotics Lab, led by Professor Bradley Nelson, is watching a screen displaying live images of the endoscopy while manipulating the joystick of a PlayStation controller. However, the operating room is in Hong Kong, more than 9,300 kilometers away.

With a delay of only about 300 milliseconds, a 4-millimeter-thick probe responds to Zurich’s signals as it moves around the stomach of a live (anesthetized) pig in an operating room in Hong Kong. Mesot guides a camera to examine the animal’s stomach wall and takes tissue samples using a tiny grasping arm.

This procedure is the first remote-controlled magnetic endoscopy. Details have just been published in the journal Advanced intelligent systems.

Two elements were decisive for this breakthrough: a magnetic navigation system developed at ETH Zurich with a magnetically controlled endoscope and a fast and secure Internet connection in the operating room.

Safety first

In the operating room, the remote-controlled procedure was assisted and monitored by surgeons from the Faculty of Medicine of the Chinese University of Hong Kong. Before Mesot took over the probe’s navigation in Zurich, it was tested in the operating room by a team from the Multi-Scale Robotics Lab and by the surgeons in Hong Kong. The latter also introduced the magnetic endoscope into the pig’s stomach through the mouth.

The endoscope is controlled by a magnetic field generated by Navion, a surgical navigation system developed by ETH Zurich Professor Nelson and his team. “Not only can the endoscope be bent in any direction thanks to its magnetic head, but it is also smaller and easier to maneuver than conventional devices,” Mesot explains.

Magnetic endoscopies are less stressful

Thanks to the high flexibility of the magnetic endoscope, Mesot was able to perform a maneuver called retroflexion in the animal’s stomach without any problems: after entering the gastric cavity, the endoscope is bent backwards by 180 degrees to inspect the stomach entrance. This complex procedure shows that magnetic endoscopes can be manipulated remotely with at least as much flexibility as standard devices.

In addition, the smaller endoscope can also be inserted through the nose in humans rather than through the esophagus, as is the case with conventional endoscopies. This method is less stressful, as the patient does not need to be completely sedated and can remain awake during the procedure to give their opinion. The magnetic endoscope can also be used in children, for whom conventional probes are too large.

Minimally invasive cancer screening and better care in remote areas

Professor Nelson from the Multi-Scale Robotics Lab at ETH Zurich is already thinking about the future. “In the next step of our research, we hope to perform teleoperated endoscopy on a human stomach. This technology has great potential. I am thinking in particular of minimally invasive procedures in the gastrointestinal tract, such as cancer screening.”

Dr Shannon Melissa Chan, Assistant Professor at the Faculty of Medicine, The Chinese University of Hong Kong, also points out: “Teleoperated endoscopy can be used not only for training surgeons, but also to provide diagnostic and surgical care in remote areas, especially where local expertise is lacking. We could even provide remote instructions to trained nurses on how to perform the procedures.”