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REVIEW 4 major objections 5 minor 43 references

EndoForce: Development of an Intuitive Axial Force Measurement Device for Endoscopic Robotic Systems

T0 review · 4 major / 5 minor · reviewed 2026-08-15 · deepseek-v4-flash

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Pith's one-line read EndoForce claims to measure axial insertion force in endoscopic robots with under half a newton of error on straight and curved paths.

desk verdict EndoForce is a thoughtfully designed proximal force sensor for endoscopic robots, but its accuracy claim rests on an unvalidated testbed reference and noise-level RMSE. read the letter →

arxiv 2505.12624 v1 pith:WOZ4Q2XB submitted 2025-05-19 cs.RO

Hansoul Kim , Dong-Ho Lee , Dukyoo Kong , Dong-Soo Kwon , Byungsik Cheon This is my paper · ORCID
classification cs.RO
keywords axialforcesensingendoscopicroboticsfeedbackureteroscopyloadcellhapticinsertionmeasurementsurgical
verification ladder T0 review T1 audit T2 compute T3 formal

The pith

A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.

The reading

This paper introduces EndoForce, an add-on device that measures the axial force acting on the insertion tube of an endoscopic robotic system from outside the body. The authors' claim is that this reproduces the force a clinician's hand would feel during manual ureteroscopy or GI endoscopy, without modifying the scope and without the bulk, cost, or environmental sensitivity of embedded sensors. The device uses a lever and hinge to redirect the insertion force onto a commercial load cell, with an overload limiter and a disposable sterile contact part. In a benchtop ureter model, the force it reported matched the sum of the friction and collision forces measured in the testbed with about 0.43 N RMSE on a straight path and 0.39 N on a curved path. If accurate, the device gives endoscopic robots the force feedback they currently lack, which the authors argue is needed to prevent tissue damage and complications.

What carries the argument

The load-bearing component is the sensing part: a force transmission arm mounted on a hinge joint, with a ball tip pressing on a seat that leads to a commercial load cell. The arm reverses the direction of the insertion-tube force and, because the ball tip forms a point contact, transmits only the axial component; the tension-spring preload removes zero-region nonlinearity; and the overload limiter stops large accidental loads from reaching the cell. Around this sit the detachable gripper and insertion tube holder with a bistable mechanism for sterile, secure tube gripping, and a timing-belt linear transport that reproduces the grasp-advance-release cycle of a clinician's hand. Together they convert a varying axial load at the scope into a linear electrical signal without embedding any sensor in the scope itself.

What would settle it

Attach a calibrated force gauge to the distal end of the ureteroscope and apply a known axial push or pull while EndoForce holds the tube in air, bypassing the sheath; if EndoForce's reading deviates from the gauge by more than about 0.4 N, the claimed accuracy does not generalize beyond the testbed.

Watch

Extended reading notes

Core claim

The paper's central claim is that axial force from the distal scope can be captured accurately at the proximal end by an external mechanism, provided the mechanism transmits force through a kinematic chain that preserves only the axial component. EndoForce holds the insertion tube in a gripper; the tube pushes a force transmission arm that rotates about a hinge, reversing the force direction and delivering it through a ball-tip point contact to a load cell. A tension spring preload keeps the ball tip seated so the load cell operates in its linear range, while an overload limiter mechanically blocks excessive forces. The paper reports that in a testbed with a 4 mm access sheath, EndoForce's reading tracked the sum of the two reference forces (friction under the sheath and collision at the distal end) with an RMSE of 0.43 N on the straight pathway and 0.39 N on the curved pathway, across three trials each.

Load-bearing premise

The accuracy claim depends on the assumption that the two testbed forces — friction along the sheath and collision at the distal end — are the only forces the insertion tube transmits to the gripper, so their sum is the true axial force EndoForce should read.

Editorial extensions

If this is right

  • A robotic ureteroscope fitted with EndoForce can provide real-time axial force feedback to the operator, restoring the tactile cue lost in remote control.
  • The disposable holder and sterile drape let the tube-contacting part be discarded after each case, so the load cell itself never needs sterilization.
  • The similar RMSE on straight and curved paths indicates the measurement is not disrupted by the bending of the insertion pathway in this testbed.
  • With a gripper that adapts to different diameters and a more compact drive, the same external sensing approach is intended to extend to GI endoscopes.
  • Connecting the measured force to a motor or vibration on the master device would give the surgeon real-time haptic feedback based on actual insertion force.

Reading between the lines

Editorial extensions of the paper, not claims the author makes directly.

  • An independent check of the claimed accuracy would compare EndoForce against a known force applied directly at the distal tip, rather than the sum of two testbed load cells.
  • The current device captures only the axial component; bending and torque cues, which also guide a clinician's hand, would require additional sensing axes.
  • Because the sensor is external and scope-agnostic, it could be used to collect labeled insertion-force data for training distal-force estimators without altering the instrument.
  • If the transport mechanism's own friction or inertia contributes to the handle force, the reported RMSE may depend on insertion speed; testing at multiple speeds would bound that effect.
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Editorial analysis

A structured set of objections, weighed in public.

Desk editor's note, referee report, and a circularity audit.

Referee Report

4 major / 5 minor

Summary. The paper proposes EndoForce, an external device for measuring the axial force exerted on an endoscopic insertion tube during robotic endoscopic procedures. The device uses a commercial load cell coupled to the insertion tube through a lever mechanism, with an overload limiter, a detachable disposable gripper/sterile drape, and a linear transport stage. The authors validate the device in a bench testbed using a commercial ureteroscope inserted through straight and curved access sheaths, and compare the EndoForce reading with the sum of two testbed load cells, one measuring friction under the sheath plate and one measuring distal collision force. They report RMSE values of approximately 0.43 N for the straight pathway and 0.39 N for the curved pathway, and claim that the device measures axial force with high accuracy. The paper also discusses future integration of haptic feedback and AI-based noise reduction.

Significance. If the accuracy claim were established, the contribution would be practically valuable: an externally mounted, cost-effective, sterilizable axial force sensor that avoids the bulk and environmental sensitivity of distal or model-based approaches. The design has clear strengths: use of a commercial load cell, an overload protection mechanism, a disposable sterile cover concept, and physical experiments covering both straight and curved insertion pathways. However, the central quantitative claim rests on the assumption that the sum of the two testbed load cells is a valid reference for the true axial force at the gripper, and that assumption is not independently calibrated or justified. Additionally, the reported RMSE values are comparable in magnitude to the reported noise level of the EndoForce signal, so the evidence does not yet support the paper's 'high accuracy' claim.

major comments (4)
  1. [Section III, Experimental Design] The evaluation defines the true axial force as the sum of the two testbed load cells, but this reference is not independently validated. The first load cell is mounted beneath the plate holding the ureteral access sheath, so it can respond to normal and lateral forces from sheath deformation and bending, especially in the curved pathway; it is not obviously a pure measurement of axial friction. Bending stiffness of the scope, inertial forces from the moving linear transport, and friction in the gripper or lever can also contribute to the EndoForce reading without appearing in the testbed sum. The authors should calibrate the reference against a known applied force or compare the EndoForce reading with an independent force sensor at the gripper, and report the resulting systematic error.
  2. [Sections IV and V, Results and Discussion] The reported RMSE values of 0.43 N and 0.39 N are not interpretable without additional context, because the average standard deviation of the filtered EndoForce signal is reported as approximately 0.45 N, which is comparable to or larger than the stated error. The paper should report the force range over which the RMSE was computed, per-trial RMSE values and their variance, the noise level of the reference load cells, and the signal-to-noise ratio. As written, the central claim of accurate measurement is not supported by the reported statistics.
  3. [Section III, Data Processing] The moving average filter used on the load cell data is not specified: the window size, whether it was applied causally or non-causally, and whether it was applied to the EndoForce signal, the reference signals, or both, are all omitted. Since the RMSE depends directly on the filtering, the reported accuracy cannot be reproduced or assessed without these details.
  4. [Section IV, Results] Each experiment was performed only three times per pathway, and the paper reports a single RMSE value per pathway without any measure of trial-to-trial variability or a statistical comparison. Given the small number of trials and the noisy signal, the authors should report the mean, standard deviation, and individual trial values for the RMSE, or justify that three trials are sufficient for the claimed accuracy.
minor comments (5)
  1. [Section V, Discussion] The text refers to 'all the data represented in lite red in Fig. 7'; 'lite' should be 'light'.
  2. [Section VI, Concluding Remarks] The phrase 'research will be performd' contains a typo; it should read 'performed'.
  3. [Author Information, Appendix A] The affiliation for the third author lists 'Department of Mechnical Engineering'; the spelling should be 'Mechanical'.
  4. [Section III, Experimental Design] The insertion speed is described as constant but its value is not reported, and the collision threshold is not quantified; both are implementation parameters that affect the measured force profile and should be stated.
  5. [Figure 7] The figure uses red, green, blue, and orange traces that may be difficult to distinguish for color-blind readers; consider adding distinct line styles or markers in addition to color.

Circularity Check

0 steps flagged · score 0.0 of 10

No circularity found: EndoForce is compared against an independently instrumented testbed sum, with no fitted parameters and no load-bearing self-citation.

full rationale

The paper's central validation claim is that EndoForce accurately measures the axial force transmitted during ureteroscope insertion. In Section III, the EndoForce load cell output is compared with the sum of two testbed load cells, one measuring friction under the sheath plate and one measuring distal collision, and the RMSE is computed in Section IV (approximately 0.43 N straight, 0.39 N curved). This is an externally instrumented comparison rather than a circular derivation: no device parameter is fitted to the testbed data, no calibration coefficient is extracted from the RMSE, and the EndoForce output is not defined in terms of the reference sum. The assumption that the testbed sum equals the true axial force transmitted to the gripper is a physical modeling assumption; bending stiffness, inertial forces, or coupling of normal forces into the plate load cell could bias the reference and make the RMSE misleading. That is a benchmark-validity or soundness concern, not circular reasoning. The paper's self-citations to prior work such as K-colon and Easycolon appear only as background and are not load-bearing for the force-measurement claim. The Discussion's admission of approximately 0.45 N standard deviation after moving-average filtering is a noise-reporting issue, not an indication that the result reduces to its inputs. No circular step meeting the evidentiary bar was found.

Assumptions & free parameters 3 free parameters · 3 assumptions · 0 invented entities

The paper is an engineering validation with no mathematical model or fitted constants. The main assumptions are about the testbed reference and the load cells. No new physical entities are introduced.

free parameters (3)
  • moving average filter window size
    All load cell data were filtered with a moving average filter, but the window size is not reported; this choice directly affects the RMSE and can mask noise.
  • collision threshold
    The experiment inserted until a force exceeding a certain threshold was detected, but the threshold value is not specified, making the test condition partially indeterminate.
  • insertion speed
    The ureteroscope was inserted at a constant speed, but the speed value is not given; transmission forces depend on speed.
assumptions (3)
  • domain assumption The sum of the two testbed load cell readings equals the total axial force at the gripper.
    Used in Section III to define the RMSE evaluation criterion without independent validation.
  • domain assumption The commercial load cell readings are linear and accurately calibrated across the measured range.
    The paper does not report a calibration procedure or accuracy specifications for the load cells used.
  • domain assumption The 4 mm inner diameter access sheath adequately simulates the mechanical interaction of a human ureter.
    The paper uses one sheath size and does not compare with tissue properties; stated in Section III.

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Cite this review

Pith. "Pith review of EndoForce: Development of an Intuitive Axial Force Measurement Device for Endoscopic Robotic Systems." pith.science (2026). https://pith.science/paper/WOZ4Q2XB

@misc{pith2026250512624,
  author       = {Pith},
  title        = {Pith review of: EndoForce: Development of an Intuitive Axial Force Measurement Device for Endoscopic Robotic Systems},
  year         = {2026},
  howpublished = {\url{https://pith.science/paper/WOZ4Q2XB}},
  note         = {Machine review of arXiv:2505.12624}
}
read the original abstract

Robotic endoscopic systems provide intuitive control and eliminate radiation exposure, making them a promising alternative to conventional methods. However, the lack of axial force measurement from the robot remains a major challenge, as it can lead to excessive colonic elongation, perforation, or ureteral complications. Although various methods have been proposed in previous studies, limitations such as model dependency, bulkiness, and environmental sensitivity remain challenges that should be addressed before clinical application. In this study, we propose EndoForce, a device designed for intuitive and accurate axial force measurement in endoscopic robotic systems. Inspired by the insertion motion performed by medical doctors during ureteroscopy and gastrointestinal (GI) endoscopy, EndoForce ensures precise force measuring while maintaining compatibility with clinical environments. The device features a streamlined design, allowing for the easy attachment and detachment of a sterile cover, and incorporates a commercial load cell to enhance cost-effectiveness and facilitate practical implementation in real medical applications. To validate the effectiveness of the proposed EndoForce, physical experiments were performed using a testbed that simulates the ureter. We show that the axial force generated during insertion was measured with high accuracy, regardless of whether the pathway was straight or curved, in a testbed simulating the human ureter.

Figures

Figures reproduced from arXiv: 2505.12624 by the authors.

Figure 1
Figure 1. FIGURE 1 [PITH_FULL_IMAGE:figures/full_fig_p002_1.png] view at source ↗
Figure 2
Figure 2. FIGURE 2 [PITH_FULL_IMAGE:figures/full_fig_p003_2.png] view at source ↗
Figure 3
Figure 3. FIGURE 3 [PITH_FULL_IMAGE:figures/full_fig_p004_3.png] view at source ↗
Figures from the paper (4 more)
Figure 4
Figure 4. Figure 4: FIGURE 4 [PITH_FULL_IMAGE:figures/full_fig_p005_4.png]
Figure 5
Figure 5. Figure 5: illustrates the operational principle of the insertion tube’s forward and backward translation, as well as the grasp￾ing and releasing mechanism. This system is designed to me￾chanically replicate the typical clinical procedure, where an operator manually grasps, advan…
Figure 6
Figure 6. Figure 6: FIGURE 6 [PITH_FULL_IMAGE:figures/full_fig_p006_6.png]
Figure 7
Figure 7. Figure 7: (a)-(c) shows the results from the experiment where the ureteroscope was inserted along a straight pathway. The data shown in light red represent the force values measured by the load cell mounted on the proposed EndoForce in this study. The data shown in light green a…

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    2024

Pith tools

Reviewed August 15, 2026 · model on record in the stance chip above.