Endoscopy has changed to robotics already - and you missed it
Now… unless you’ve been sleeping under a rock for the past few years then you will already know that Endoscopy in all aspects has gone robotic. Clearly in bronchoscopy with Ion, Monarch and Galaxy. But now we are seeing endoluminal robotics in urological as well. It is already heading that way and still the vast majority of people are asleep - and not understanding we are already in the middle of the next wave.The future is not more Xi like robots. The future is getting disease early - and see n treat. Stopping cancer before it becomes cancer. Treating metabolic disorders with endoluminal therapies. Endoluminal structural procedures that replace structural surgery - such as gastric sleeves.
In this paper I laid out clearly where I see the future going - and if you haven’t read it. Read it: https://www.howtostartupinmedtech.com/post/endoluminal-robotics-what-it-really-is
If you have read it in the past but were a little skeptical - then re-read now in the light of the last 6 months of major announcements.
And if you need more convincing - don’t take it from scum bag like me - take it from an endoscopist.
So what has happened recently in endoluminal robotics?
Well we now have much more detail on the IG1000 by Intuitive - and I will do a full explainer video on this technology. But in short it’s a robotic twin lumen endoscope with attachments. It is robotically driven - no more weird thumb wheels and poor ergonomics. It shapes locks - it navigates - it is stable - and for now is upper GI - for now.
It is a clear dive into building the next platform of robotics - the next leg of the stool for Intuitive. And if I was Boston Scientific I would be shitting my pants. Because who owns the railroad decides what cars go on it. And Intuitive is a razorblades model company. Bye bye - endoscopy consumables..... (Oh not at the start..... but just wait.)
Olympus wised up and invested heavily in the build to buy of Swan Endosurgical - so are heading to a bi manual endoscopic robot. READ my article why BI-Manual is the real deal future. But in the mean time they have a stratified approach with their agreement with Endorobotics to have robotic endoscopy and upgraded therapeutic capabilities.It goes - manual endoscopy > Robotic diagnostic endoscopy > Robotic see n treat simple procedures > robotic advanced bi manual procedures > Trans luminal procedures etc etc. Olympus is putting stakes in all the camps. Smart - wise - not going to be left behind by Intuitive.
I do predict once you go robotic - even for diagnostic - the upgrade is like lap to surgical robotics. Stable vision - ergonomics - advanced instruments - stable locked platform - data - there is NO going back.
Again if I was Pentax or FUJI - I’d be getting my ass in gear NOW and I mean now - not the usual “Japanese wait and see” or you will be history in 5 years !!! (Yes read that right!)
Now - what else is happening - well Neptune Medical got FDA on their Triton robotic system - that uses sleeve on sleeve locking technology to give that stable platform. To help make EMR and simple ESD easier. Not too much given away in images but one to watch. Again it’s a “platform” and far more to come.
This is a render of their "sleeve in sleeve" system and it clearly as robotic advancement and steering
The small footroint of this system looks built for the endo suite and clearky a connected system by the looks of the lan ports.
As indicated - one of the biggest reasons all of these systems will replace manual is the digital archtecture and stability. This navigation screen gives so much away. Top left - it will allow for force analysis - critical for less pain proedcures - less risk of perforation. You can see Torque guages and a critical part of the systems that will be unparalled with manual - will be to reduction of looping and the issues that causes for users and patients. Super stable imaging. And clear lumen guided diagnostics - which is clear this eventually goes to autonomous driving.
A future where the scope drives in - less pain - better stable images - no ergonomic stress fo the user - 100% guaranteed reaching the ileocaecal junction - perfect polyp visualisation - and a stable plaftorm with "hands free" to deliver tools to perform EMR and ESD etc.... why the F would anyne want to cling on to manual scoping. Oh come on.
Back to Olympus - they have clearly already worked that out - the Endorobotics system does just that. And by the way - they do know a bit about scopes.
So if the number one endoscopic compoany onb the planet is saying "this is going robotic" - to have people still doubt in any way shape or form that this is the direction of travel is utter madness. And to have Intuitive get into this space - "hello!!!!"
And again - don't take my bumbling word for it - that it's viable - real - works. Just read the publications already out - the real CLINICAL use of these systems. They are good. Please don't start with we need RCTs. It isn't going that way... it's going robotic so get off your academic perch and realise the train has already left the station. It is not going to be about RCTs - just as surgical robotics was not. Or stents were not... they were driven by companies and the market - and you can accept that or live in your bubble. No next gen of endoscopists are going to tollerate the ergonmics - complexity - and lack of digital assistance. Not happening.
Also there's INEN from IRCAD… and of course Medtronic and JNJ will be looking attentively at this. They have to - because my bold prediction is that 30% of current surgical procedures go away.
Endoquest with the PARADIGM trial is the first evidence of that. In 30 patients... 3 of the ESDs were seen to be cancerous. So those three patients dodged that bullet. If they had not had that procedure they were later on for colorectal cancer surgeries. 10% gone !!!! Gone from surgery.Intuitive have clearly seen the writing on the wall and have taken the lead for the big three surgical companies - pushing the puck to another place while the other two companies are wrangling with their Gen 1 surgical robots. If the endoluminal plays out as I believe - then this sucks oxygen out of the room at a faster rate.
The interesting thing for me is how many in industry and how many clinicians are still in denial. I get calls saying “don’t see it - can’t see people using robots where they can use a manual scope…”
It is ground hog day for me back to 1999 “No one os going to use a robot for surgery!” FFS - have you learned nothing?!?!?!?!!?
The train has left the station and Endoquest are already out in the lead. We have Intuitive hot on their heals - Olympus via Swan working it out. When you have Intuitive and Olympus leading the charge - then know it’s changing. Period!!!!
In my confused head - this is an opportunity way bigger than surgery !! And I know people have argued (good debate is good as I'm often wrong... vocal... but wrong) that it’s as big an opportunity by current numbers. BUT I’d say they haven’t understood where this really goes. They are reading some small current ESD numbers by super specialists. That changes. YOU could do an ESD with these systems - and just wait until autonomy kicks in.
Just like 1990 “Laparoscopy pahhh chopstick Nintendo."
Just like 1999 “No none will use a robot for laparoscopy”
Staplers - Stents - TAVR - the list goes on. And the next frontier is endoluminal GI. And it is here and it is now: so get on the train because it has already left the station. Oh and if you’re a clinician - you have the chance - and one chance - to be the pioneers. Don’t be clinician 123,000 that eventually changes practice after saying it is stupid for 10 years. Clinging to "a great endoscopist doesn't need a robot."... I've seen how that worked out for the lost generation of manual laparoscopist "purists" that all now use the robot having missed the best 10 years to guide it...
These are just musings and speculations by the author for provocative educational purposes only.
