The ideal procedure to diagnose a colon disease should be safe, well-tolerated, possibly non-invasive, with high diagnostic accuracy and, not least, cost-effectiveness . Despite at present colonoscopy performed with multiuse endoscopes with multipurpose is an examination performed routinely, the real cost associated with the procedure is not truly known. They are, in fact, very few papers published on the subject and these include the aforementioned study of Ofstead, which, however, provides partial data as it relates to the only phase of reprocessing of the tools and a recent analysis conducted by Larsen . In this latter paper the authors found that the cost per colonoscopy including the purchasing, maintaining and reprocessing cost of the endoscopes, is within a range from € 173.72 ($ 188.64) to € 461.52 ($ 501.16) respectively for centres that perform at least 3,000 procedures and centres that perform 1,000 per year. The authors have analysed also the costs related to the development of post-procedural infections in patients undergoing traditional colonoscopy; in this case, an additional cost of € 18.53 ($ 20.12) and € 42.84 ($ 46.52) respectively are added to the previously reported values  rising the cost of colonoscopy without anaesthesia to € 192.25 ($ 208.76) and € 504.36 ($ 547.68). Furthermore, with regard to clinical efficacy, despite limited scientific evidence comparing conventional and robotic colonoscopy using the Endotics System, the most recent study about Endotics System reports 93.1% success of robotic colonoscopy in reaching the caecum in patients with a history of failure of conventional colonoscopy.
In just 7 subjects (6.9%) the exam was not completed; nevertheless, in 5 cases out of 7 it was possible to surpass the segment of the colon reached by traditional colonoscopy and in 2 cases the same intestinal tract was at least reached . Furthermore, a relevant factor highlighted by the scientific evidence currently available is represented by the high level of tolerability of the robotic procedure by the patients. In 2010 a study of 71 patients undergoing colonoscopy with either techniques, reported the administration of midazolam and meperidine in 19.7% of patients treated with conventional colonoscopy, while no sedation was required when subjected to the procedure with the robotic system . Potentially, this can be considered a predictive index of greater adherence to the diagnosis by the patient, whereas in Italy 20% of patients with Fecal Occult Blood Test (FOBT) positive do not undergo the subsequent colonoscopy . A further positive element concerning robotic colonoscopy is represented by the data, recorded in normal clinical practice, related to the short learning curve necessary for the correct use of the medical devices; it is, however, necessary additional ad-hoc studies to confirm the significance of this figure. Despite conventional colonoscopy is currently the gold standard among the methods available for the screening of colorectal cancer , there are various risks factors associated to this type of procedure, ranging from cardiopulmonary complications [19, 20], the perforation of the colon [21, 22], to the risks associated with anaesthesia in painless conventional colonoscopy, especially if performed on paediatric patients or with comorbidities [23, 24]. Besides, the fact that anaesthesia is not required in robotic colonoscopy, determines a series of social-organizational and also economic advantages related to the patient: greater autonomy of the subject being examined, lack of influence of the procedure on the patient’s driving ability, hence giving the possibility to the patient to come to examination unaccompanied, the ability to take important decisions or sign contracts within 24 hours of the procedure ; these are all elements that influence the indirect costs related to the evaluation of technology, which have not been the subject of this study, but which nevertheless have an important role on the overall analysis of the study. Another important aspect is represented by the disinfection process to which conventional colonoscopes are subjected between each use; the risk of infection related to the reprocessing phase is well known [26, 27]. The Emergency Care Research Institute (ECRI), in its latest release on the 10 greatest risks associated with the use of health technologies of 2018, shows in the second position, the risk of contamination related to the failure of the reprocessing. According to the document, the areas that require attention include especially the cleaning step, performed manually, and the conservation of the instrument after the disinfection . Finally, among the problems related to conventional colonoscopy, the literature also reports a high prevalence of musculoskeletal disorders, in particular in the upper limb district, related to the endoscopists personal ability and in relation to the number of tests performed [28, 29, 30, 31].