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Sammy Heung

With the help of a game controller, researchers in Switzerland successfully used a magnetically steered endoscope on a living pig 9,300 kilometres (5,780 miles) away in Hong Kong to perform a biopsy on its stomach wall.
The procedure was the world’s first remotely controlled endoscopy on a living pig involving a magnetic navigation system and is part of a collaboration by the Chinese University of Hong Kong (CUHK) and the Swiss Federal Institute of Technology Zurich (ETH Zurich).
Professor Bradley Nelson, the head of ETH Zurich’s Institute of Robotics and Intelligent Systems, said the breakthrough meant telesurgeries in the future could be performed in remote regions such as developing countries where expertise was often in short supply.
“We’re able to, over thousands and thousands of kilometres, have very precise control of an endoscope, a new type of endoscope, and to do a scan of a patient’s stomach,” he added.
“Being able to treat more patients around the world – I think is the long-term vision.
“What we’re going to be able to see is we’re going to be able to deliver the quality of healthcare we have here in Hong Kong to the rest of the world.”
He added that human trials were expected to be carried out in two years.
The endoscopy procedure, carried out in May, involved two operators on different sides of the world – a doctor at CUHK’s Multi-scale Medical Robotics Center in Hong Kong’s Science Park and an expert in Zurich.
The Zurich expert handled the teleoperated system with a control console and a robotic agent translated commands into actions in Hong Kong.
The communication between the control console and robotic system was set up by a computer communication protocol called WebSocket, which allows real-time data transfer to and from a server computer.
The server computer was placed next to the operation bed. It also established wired communication with Navion, a portable magnetic navigation system, and a magnetic endoscope and robotic set-up.
The endoscope designed by Nelson’s team has a diameter of less than 5mm and is steered by magnetic fields, which allows it to make U-turns.

Professor Philip Chiu Wai-yan, the dean of CUHK’s medical school, said the new design allowed the endoscope to be thinner and offered more flexibility and navigability than a traditional one.
The magnetic endoscope might also be applied to cholangioscopy, which involves bile ducts, and enteroscopy, which evaluates the small intestine, as well as fetoscopy, he added.
“Now we normally insert the cholangioscope into the duodenum and go further into the bile ducts with some probing tools, Chiu said.
“In the future, with this magnetic technology, which allows the endoscope to bend backward, we may directly insert the endoscope into the bile ducts.
“For twin babies, there is a disease called the twin-to-twin transfusion syndrome where the two babies share their blood vessels. The magnetic endoscope may be able to separate the connected vessels with a laser.”
Chiu said the new technology could also reduce the number of people needed to carry out endoscopies, which are in huge demand in Hong Kong.
“The endoscope can be controlled by a joystick. It is not necessary to have an expert to use it,” he said.
“Traditional endoscopes have a diameter of 9mm to 10mm. The 4mm endoscope makes it more comfortable for the patients and can be controlled by technical staff. You can imagine that it enables more patients to undergo endoscopies.”

Chiu added that endoscopes were soft instruments with limited accuracy, but the use of magnetic fields was a breakthrough that allowed for accurate control of the device without the intervention of doctors.
He said the system was able to tolerate a latency of half a second or above, and the demonstration showed there was a delay of about 200 milliseconds, something that was undetectable to the human eye.
The project began in 2020 when the Zurich team was in charge of the invention of the robotic system and CUHK provided clinical advice.
Nelson said there would need to be more risk analysis, but the technology’s use of magnetic fields was “inherently safe” and was expected to be “very well tolerated” by patients.
He added the problems in development of the technology included generating magnetic fields and designing the endoscope.
“They’re very precisely shaped and there’s a lot of maths and physics … it’s been a long process of understanding how to generate those fields,” Nelson said.
“There’s a lot of design work. There are a lot of special materials that are chosen as well as the electronics.
“All of these engineering aspects take years to get right and they also take strong collaboration with clinicians.”
Chiu said they aimed to conduct human trials in two years.
He added that more work was needed to ensure the telesurgeries’ safety, accuracy, hygiene and whether the equipment was of a medical grade.
Chiu said basic clinical infrastructure and a stable internet connection were required to conduct the telesurgeries and reduce risks caused by potential delays.


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Collaboration by ETH Zurich and CUHK is world’s first use of remotely controlled endoscopy on a living pig involving magnetic navigation system


Collaboration by ETH Zurich and CUHK is world’s first use of remotely controlled endoscopy on a living pig involving magnetic navigation system.


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