Eye-tracking technology has great potential as a novel control system for luminal endoscopy. The control system of the endoscope has remained unchanged for several decades. The conventional endoscope is controlled by two wheels attached to antagonistic cables that steer the endoscope tip [1]. This steering mechanism in combination with the flexibility and looping of an endoscope makes conventional endoscopy a challenging skill to acquire with well documented poor ergonomics and a steep learning curve [2, 3].

The remit of luminal endoscopy continues to expand, nonetheless. Endoscopic submucosal dissection is a valuable technique allowing resection of complex lesions which may help avoid surgical colonic resection as well as reduce risk of recurrence vs endoscopic musical resection. Other third space endoscopic procedures such as Per Oral Endomyotomy (POEM) for achalasia are increasingly employed as a non-surgical management option [4]. These techniques require fine movement with small errors of margin between a successful procedure and a perforation [5, 6] and high demands on mental workload. Due to the fine bimanual control required, the endoscopist is also reliant on assistants to operate the various instruments required during the therapeutic endoscopy.

There have been several novel robotic endoscopic platforms proposed and trialled to facilitate intuitive endoscope control. All these systems are reliant on manual control platforms which are predominantly joystick based. Those focussed on advanced therapy have novel control systems to both allow intuitive steering of the endoscope and control of endoscopic instruments such as dissection knives. These systems are expensive with large footprints, are bimanually controlled and in some cases require more than one operator [7].

Eye tracking of endoscopist’s gaze patterns is an increasingly studied area providing valuable insights into the visual gaze patterns most suited to lesion detection as well as being used as an objective tool to compare new endoscopy-imaging technologies [8]. We have previously presented a novel gaze-controlled endoscope utilising gaze tracking as a control system rather than a research tool. Using eye-tracking glasses and a motorised system the endoscope tip follows the direction of the endoscopist’s gaze. In the previous system head tilting, and forward and backward movement by the user was able to rotate and insert and withdraw the scope. The initial gaze system was entirely hands free [9].

The system has undergone multiple reiterations to produce the updated and more ergonomic system: iGAZE2. The system now has gaze-controlled tip steering, but insertion and withdrawal are performed with the right hand. This system has a significantly smaller footprint with a miniaturised motor system with low-cost components that can be easily fitted to any conventional endoscope.

In this study, we trial the new system (iGAZE2) with novices to assess the feasibility, intuitiveness, and workload of this system vs a conventional endoscope.