A robotic rectum, developed by scientists at Imperial College London, has been designed to help doctors and nurses train to perform digital rectum exams for prostate detection, and to practice performing the screening without live volunteer subjects.
Its the cancer screening test men usually dread most, described by the American Cancer Society as when the clinician inserts a lubricated finger into the rectum to feel for bumps or hard areas on the prostate that could be cancer.
The prostate is located just inside the anus in front of the rectum and can be felt through the rectal wall. Prostate cancers often begin in the back part of the gland where they might be detected by the doctor or nurse during a rectal exam. The exam is usually the first test to detect rectal problems and to determine if a patient needs further tests.
While DREs involve varying degrees of discomfort, they are usually not painful and take only a short time.
Graphic courtesy The American Cancer Society
However, doctors and nurses need training in DRE procedure and technique, and volunteers are unlikely to line up to be practice subjects. Some associated issues are discussed in the research article “Digital rectal examination skills: first training experiences, the motives and attitudes of standardized patients,“ published in the journal BMC Medical Education.
A robotic rectum developed by scientists at Imperial College London is designed to help doctors and nurses train to perform DRE for prostate detection, and to gain realistic experience performing DREs without live volunteer subjects.
In a press release. Dr. Fernando Bello of the Department of Surgery and Cancer at Imperial College London said cancerous prostates tend to be hard and knobbly, but learning exactly what a potentially cancerous prostate feels like can be difficult.
“Internal examinations are really challenging to learn – and to teach. Because the examinations occur in the body, the trainer cannot see what the trainee is doing, and vice versa. In addition to this, medics rarely get the chance to practice the examination, as few patients would volunteer as practice subjects.”
Only one person in the UK is registered as a test subject, called a Rectal Teaching Assistant.
Approximately one in eight men in the UK will have prostate cancer during their lifetime and 75 percent of males over age 70 have benign prostate enlargement which, although not life-threatening, can cause urinary discomfort and dysfunction.
Other high-tech prosthetic rectums have been developed, but none incorporated the advanced haptic technology and 3D modeling providing detailed feedback to clinicians like the Imperial College device.
Bello’s main research interests are medical visualization and analysis, surgical simulation, augmented reality and image guided surgery. A significant proportion of the work in his lab focuses on investigating and promoting new technologies for education and clinical practice, such as the robotic trainer rectum.
The technology, consisting of prosthetic buttocks and rectum, accurately recreates the feel of a real human rectum and provides feedback on the skilfulness of the trainee’s examination technique. The DRE trainee inserts a finger inside a silicone thimble wired to robotic technology designed to recreate the exact sensation of the rectum. Small, computer controlled robotic arms in the device apply pressure to the rectum, creating a realistic simulation of the shape and feel of the male back passage. A version of the device is being adapted for training in gynecological exams.
The robotic rectum technology was presented at Eurohaptics, a major international conference on haptic technology and touch-enabled computer applications, July 4-7, at Imperial College London. Eurohaptics is the primary European meeting for haptic researchers under the auspices of the Eurohaptics Society,
“Haptics is one of the most exciting technology areas at the moment, (it) investigates the sensation of touch and how to integrate this into electronic devices,” Bello said. “It has huge implications for the field of medicine and beyond.”
Dr. Alejandro Granados from Imperial College London demonstrates the robotic rectum technology, which he has developed to enable medical professionals to practice rectal exams – Photo courtesy Imperial College London
The device can also display a 3D model of the rectum and prostate on a computer screen, allowing the doctor, wearing 3D glasses, to observe the anatomy during the examination.
Dr. Alejandro Granados, of the Imperial College Department of Surgery and Cancer and development leader of the robotic rectum project, said the technology can be programmed for different scenarios because the anatomy can be changed.
Volunteers underwent MRI scans that were later used to perfect the shape and geometry of the anatomy. Clinicians, prostate specialists and cancer surgeons then tested the technology.
“They commented on the great advantage of being able to alter the anatomy. The size and shape of the rectum and prostate can vary greatly from person to person, and this technology enables medics to practice their skills in many different virtual patients. They also observed that because these examinations are performed solely by feel, experiencing a realistic sensation is crucial,” Granados said in the press release.
The project is funded by the Engineering and Physical Sciences Research Council (EPSRC).
The Imperial College research team is now working toward building an affordable prototype for medical schools, and is continuing to refine the device based on data collected from real prostate examinations.
“There is very little research into the exact pressure and trajectory a doctor needs to use for a successful prostate exam,” Bello said. “Therefore we are asking doctors to wear a small pressure sensor on their fingertip, underneath their surgical glove, when they are examining real patients.”
The cost of the Imperial-developed trainer rectum device, possibly more than 10,000 euros per unit, could limit its use in medical schools. The research team proposes that a more affordable alternative could be to use only the finger pressure sensors and 3D software with traditional plastic training devices.