Endoscope design for the future

A preponderance of evidence, primarily from surveys, has shown that gastroenterologists suffer from overuse injuries and pain of hand/fingers, wrist, forearm, shoulder, and back due to awkward postures, high forces, and repetitive movements during endoscopy. Although flexible endoscopes are brilliantly designed compact instruments that include light and image guides, irrigation channels, suction channel, biopsy channels and are the result of many technological advancements and iterations in the last 5 decades, not much has changed in their basic functions, layout, ergonomic design, and usability. The required hand-tool interaction in order to maneuver the endoscope inside the intestinal lumen, such as stabilizing the control section while manipulating dials with the left hand while simultaneously torqueing, pushing, and/or pulling the insertion tube with the right hand, are still unchanged. It is imperative that the scope manufacturers understand the ergonomic areas of concern in the design of current endoscopes and incorporate ergonomic principles in future designs to optimize the interface between the instrument and the physician. In addition, it is as important for the physicians to be educated on ergonomic principles to minimize the risk for endoscopy-related injuries. This chapter reviews the design of current endoscopes and the ergonomic areas of concern. We review endoscope design changes that are needed to mitigate risk of injury during endoscopy, possible innovations that may improve endoscope ergonomics in the future, and barriers to implementation of any intervention that will address these shortcomings.