Funded by EPSRC Pathways to Impact Awards 2015-2016

Project summary

Haptic Rectal Examination Trainer
ICCESS prototype DRE Simulator

Digital Rectal Examination (DRE) is important for the diagnosis of anorectal abnormalities in primary and secondary care and plays a critical role in the early detection of rectal and prostate cancers. DRE is also usually the first test done to diagnose the highly prevalent Benign Prostate Hyperplasia (BPH – enlargement of the prostate with age). Bowel cancer screening guidelines recommend DRE as an initial screening test in all patients with recent rectal bleeding or other suspicious symptoms.

DRE is routinely performed by GPs, Urologists, Colorectal Surgeons / Nurses and Nurse Practitioners. It requires the clinician to insert a lubricated gloved finger into the back passage to detect or exclude rectal disease, BPH and other prostatic abnormalities (men) and cervical pathology (women). DRE is uniquely challenging to learn and teach, since visual cues are minimal (conducted almost entirely by feel). Novices must use their finger to build up a mental representation of the anatomy and learn to recognise normality and disease. Crucially, instructors are unable to feel what novices are feeling, so cannot provide effective guidance or assess performance.

Simulation offers obvious benefits, allowing learners to practise repeatedly and to build up skills in safety. Whilst there exist a variety of benchtop models, they have major deficiencies: 1) the instructor cannot ‘show a novice how to feel’, or record and assess their progress; 2) the wide range of normal and abnormal findings is not adequately reproduced; 3) currently available simulated tissues do not feel authentic. 

Project aims

Haptic rectal examination trainer in use
The haptic DRE trainer in use

The aim of this EPSRC-funded current phase of the ongoing project is to develop a commercial prototype of DiRECTS.  This will include a redesign of the prototype haptic device, finger thimble and active sphincter mechanism, new modular software structure, improved prosthetic model with realistic surrounding external tissues, Graphical User Interface, content and performance feedback.

Progress and outputs

Project team

Dr Alejandro Granados Martinez

Dr Alejandro Granados Martinez
Project lead