In vitro development of the Autonomous Colonoscope Robot System (ACRS) for fully automated colonoscope insertion

In the field of colonoscopy, robotic systems have been developed to support or replace human operators due to a shortage of trained endoscopists. We developed the Autonomous Colonoscope Robot System (ACRS), based on the Endoscopic Operation Robot version 4, to evaluate whether expert-derived operational data can enable autonomous colonoscope insertion.

ACRS was trained using insertion data obtained from an expert endoscopist operating a standardized colonoscopy training model. Automated insertions were evaluated using Pattern 1 of the model, a highly controlled configuration without substantial loop formation. Completely automated insertions were designated Level 4, whereas insertions requiring some manual assistance were designated Level 3. Level 4 insertion times were compared with manual insertions performed by an expert and trainees.

Of the 72 automated insertions at Level 3 or higher, 62 are classified as Level 4, giving a success rate of 86.1% (95% CI, 75.9-93.1%). The average insertion time for Level 4 procedures is 2.92 ± 1.20 minutes, significantly longer than that of the expert (1.43 ± 0.32 minutes), but comparable to the time taken by trainees (2.97 ± 1.32 minutes; errors are standard deviations).

ACRS demonstrates proof-of-concept feasibility for autonomous colonoscope insertion under simplified, controlled model conditions. Further validation in more complex models, animal studies, and clinical settings is required before translational application.