Objective: To evaluate the feasibility and safety of the robot-assisted system YunSRobot for remote manipulation endoscopy. Methods: When the master of YunSRobot was installed in the gastroenterology office in Chinese PLA General Hospital, the robot slave and upper gastrointestinal simulation model (Takahashi Lm103, Japan) were installed at the same time in the State Key Laboratory of Robotics, Shenyang Institute of Automation. Three physicians were trained to operate the master robotics and performed gastroscopy on the simulation model based on network cloud. Each physician performed 3 procedures of oesophagogastroduodenoscopy (EGD) by YunSRobot using traditional manual endoscopy, on-site operating mode, and remote manipulation mode, respectively. The operating time, lumenal anatomic exposure, man-machine interaction and other parameters were recorded. Results: The number of standard pictures obtained by traditional manual endoscopy group, on-site operating group and remote manipulation group were 39.9±0.3, 39.8±0.4, 39.9±0.3, respectively. The images of all five lesions could be obtained by each operation. The operating time in the duodenum of remote group was longer than that of on-site group, with average time (78.2±16.0)s vs. (68.9±15.8)s (P=0.021) respectively. As to the operating time on other parts or total time, all three groups were comparable. Although there was a mean delay of (572.1±48.5) ms in remote operation group, the operation was still smooth. However, compared with on-site group, the percentage of clear view time in the duodenum was significantly shortened in remote group: [(77.8±8.2)% vs. (83.9±6.4)%, P=0.024]. Statistically significant difference was detected in percentage of clear view time neither in other sites, nor was in the total operating time between two groups. The operating time in each part of remote group was obviously longer than that of manual group as followings, pharyngeal (27.3±4.2) s vs. (9.2±1.3)s (P<0.001), esophageal (29.7±6.4)s vs. (19.3±1.6)s (P=0.004), stomach (56.7±17.0)s vs. (40.3±7.0)s (P=0.003), pylorus (20.2±5.5)s vs. (9.3±1.3)s (P<0.001), duodenum (78.2±16.0)s vs. (29.3±5.6)s (P<0.001). Thus the total operating time was also longer in remote group as (559.0±87.2)s vs. (253.1±16.6)s (P<0.001). The respective time in pharynx, esophagus, stomach, pylorus, duodenum, or the overall time was all longer in remote group than that in manual group. Conclusions: The soft endoscopy robot YunSRobot has satisfactory safety and stability. Remote upper gastrointestinal endoscopy can be completed based on common network and an endoscope simulation model with smooth operation. The inspection time by YunSRobot robot per part and the overall time are longer than those of manual operation on site, still, remote operating time meets the standard of upper gastrointestinal endoscopy.
目的： 评价软式内镜操控机器人YunSRobot进行远程内镜检查的可行性、安全性。 方法： 由3位已接受机器人培训的医师分别采用3种方法对同一上消化道仿真模型进行内镜检查，即直接使用胃镜进行检查、现场操控机器人检查、远程操控机器人检查各3例，共完成27例次上消化道内镜模型检查操作。其中，远程操控机器人内镜检查步骤如下：安装YunSRobot机器人主端于解放军总医院内科楼消化病区办公室（北京），机器人从端、上消化道仿真模型（日本高研Lm103）安装于中国科学院沈阳自动化研究所机器人实验室，主端通过公共网路云端控制机器人对仿真模型进行内镜检查。所有操作记录各部位进镜时间、总时间、各部位观察情况、人机互动友好情况等，进行对比研究。 结果： 按照胃镜规范化图像采集标准（涵盖各部位清晰图片共40张），直接使用胃镜组、现场操控机器人组、远程操控机器人组分别获得图像张数为39.9±0.3、39.8±0.4、39.9±0.3，每次均能获得全部5个病变的图像，各组比较差异无统计学意义。远程操控机器人组在十二指肠检查（从进入到退出十二指肠）时间大于现场操控机器人组[(78.2±16.0)s比（68.9±15.8）s, P=0.021]；其他各部位进镜时间以及总操作时间，两组间差异无统计学意义。远程操作平均延迟时间为（572.1±48.5）ms，操作流畅，术者无延时感。从清晰时间百分比角度，远程操控机器人组在十二指肠要低于现场操控机器人组[(77.8±8.2)%比（83.9±6.4）%，P=0.024]；其他各部位进镜以及总操作清晰时间百分比，两组差异均无统计学意义。远程操控机器人组与直接使用胃镜组的各部位进镜时间分别为：咽部（27.3±4.2）s比（9.2±1.3）s (P<0.001)、食管（29.7±6.4）s比（19.3±1.6）s (P=0.004)、胃（56.7±17.0）s比（40.3±7.0）s (P=0.003)、幽门（20.2±5.5）s比（9.3±1.3）s (P<0.001)；十二指肠检查时间（78.2±16.0）s比（29.3±5.6）s (P<0.001)；总操作时间（559.0±87.2）s比（253.1±16.6）s（约相当于9.3 min比4.2 min）(P<0.001)；t检验结果显示，远程操控机器人组操作时间无论是在咽、食管、胃、幽门等部位的进镜时间、十二指肠的检查时间，还是总体检查时间均长于直接使用胃镜组，差异有统计学意义。 结论： YunSRobot软式内镜机器人具有良好的安全性和稳定性，可顺利实现基于普通网路内镜模型的远程上消化道内镜检查，且操作感流畅、术者无延迟感；远程操控机器人各部位进镜时间和全程检查时间长于直接使用胃镜组，但YunSRobot机器人远程操作完成一个上消化道内镜检查的时间仍在标准内镜检查时间范围内。.
Keywords: Remote manipulation; Soft endoscopy robot; Upper gastrointestinal simulation model; YunSRobot.