Status of robotic and manual devices for advanced colonoscopy: Trends and applications of robotics in colonoscopy

Abstract

The development of colonoscopy technology aims to enhance diagnostic accuracy while speeding up procedures, improving patient comfort, and addressing the technical limitations of standard endoscopy. The latest technological advancements include robotic and manually assistive systems, which provide better navigation, real-time feedback, and automated capabilities. This review compares the current status of manual and robotic assistive devices in colonoscopy, including their underlying mechanisms, clinical performance, and adoption status. A narrative review of the literature was conducted, examining commercially available and investigational devices that enhance colonoscope navigation, reduce patient discomfort, and automate endoluminal procedures. The devices were classified into two groups: Manual assistive systems (ScopeGuide, Third Eye Retroscope, NaviAid) and robotic platforms (Endotics, NeoGuide, Invendoscope, Aer-O-Scope). The clinical performance was evaluated by cecal intubation rates (CIR), adenoma detection rates (ADR), procedural times, and complication profiles. Manual assistive systems showed gradual improvements in loop reduction, retroflexion, and positional feedback with CIRs ranging from 93% to 100% and variable ADR outcomes depending on operator training and use patterns. The robotic colonoscopes showed CIRs ranging from 82% to 98%, and some platforms (Endotics and Aer-O-Scope) achieved reduced patient discomfort and minimal sedation use. Several devices have received Food and Drug Administration and European Conformity clearances, but their adoption remains limited because of their high costs, technical complexity, and insufficient large-scale validation. Also, the available evidence is limited by heterogeneity and the predominance of small, early-stage studies. Overall, the integration of robotic and manually assistive devices in colonoscopy shows promise as they may provide better ergonomics, reduced pain, and potential quality metric improvements. These findings suggest potential benefits in improving colorectal cancer detection, patient comfort, and procedural accessibility. However, despite technological advances, conventional colonoscopy remains highly effective, while current robotic platforms are limited by high costs and a lack of clear superiority, contributing to their restricted clinical adoption. The future development should concentrate on real-world usability, device standardization, and head-to-head comparative trials to validate clinical value. Ultimately, widespread adoption will require clear clinical benefit and economic justification beyond current standards.

Keywords: Colonoscopy; Robotic colonoscopy; Manual assistive colonoscopy; Advanced colonoscopy; Cecal intubation; Adenoma detection

Core Tip: Conventional colonoscopy remains limited by patient discomfort, loop formation, and operator dependence, prompting the development of manual assistive and robotic technologies. This review summarizes current advanced colonoscopy devices, comparing their mechanisms, clinical performance, and real-world adoption. Manual assistive devices provide gradual improvements with minimal workflow disruption, while robotic systems demonstrate promising reductions in pain and sedation requirements but face cost and implementation barriers. Although widespread clinical adoption remains limited, ongoing advances in automation, magnetic navigation, and artificial intelligence suggest a future role for hybrid and robotic systems in improving procedural quality and patient experience.