Global Assessments of the Endockscope System: Long-Term Impact of Cyber Endoscopy

In the world of commerce, the expression “level playing field” is a concept about fairness, not that each player had an equal chance to succeed, but that they all play by the same set of rules. In medicine, this concept manifests much differently: rather than having a focus on “success,” patient outcomes and lives are at stake. This article from the University of California, Irvine Department of Urology, provides a prime example of how current medical technology and innovative thinking have come together to create a device that “levels the diagnostic playing field.” The Endockscope System (ES) provides urologists globally, especially those from resource-challenged countries, an effective and inexpensive system that allows them to successfully perform and expand their use of urological endoscopy.

The Endockscope is a device that utilizes an everyday smartphone, such as an iPhone or Samsung Galaxy, and combines it with a lens system and rechargeable LED light source to provide a $45 laparoscope that can be used in endoscopic procedures. Compared to standard cameras and high-power light sources that are used to power conventional endoscopes in the operating room, the Endockscope is a much lower cost alternative. By creating an interface for use with widely available smartphone technology, anyone with the Endockscope (3D digitally printed support) adaptor and a battery-operated power source can capture video for endoscopic procedures with clarity for viewing urologic pathology at an affordable price that avoids the need for expensive, more dedicated camera imaging systems.

Across the world, flexible ureteroscopes are the gold standard for the diagnosis and treatment of ureteral and renal diseases ranging from kidney stones to upper tract malignancies. However, given the high cost of these fragile endoscopes, the need for frequent expensive repairs, and the cost of the accessory camera and high-powered light source (which could cost almost $45,000), this technology is unavailable in many countries. Moreover, when such equipment is present, it is usually available only within major hospitals in urban areas, burdening a large subset of patients with the necessity of traveling great travel distances in order to undergo endoscopic evaluation.

Researchers evaluated the use of their Endockscope System after 4 years from its initial launch through survey responses from 40 urologists in 23 different countries. The majority of participants reported having used the ES device over the time they had it and the individuals who reported using it the most were urologists from the most impoverished countries. Many urologists reported that they were able to perform more endoscopic procedures directly because of the ES, with some participants even reporting that they found the ES equal or superior in quality to their standard endoscopic equipment.

Clearly, this article has its limitations, such as researchers’ inability to contact more individuals who had their device for four years, and there are still many hurdles for this team to overcome as they continue to make improvements and modifications to their current device. However, as the SARS-CoV-2 (COVID-19) pandemic has shifted the global landscape, particularly with regards to remote administration of medical care, combined with the fact that urologists are now being asked to see more patients with complex problems, it would appear that there is significant promise in how the Endockscope may contribute to the advancement of telemedicine by allowing expert endourologists in one part of the world to examine, diagnose, and guide video endoscopy and health care as a whole in another part of the world. In this way, the Endockscope may be a very important tool to help empower urology specialists to educate and interact with other physicians worldwide.

Written by: Andrew Afyouni, MD, & Roshan M. Patel, MD, University of California, Irvine

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