J Robotic Surg (2013) 7:5357
DOI 10.1007/s11701-012-0346-3
ORIGINAL ARTICLE
Measurements of the contact force from myenteric
contractions on a solid bolus
Benjamin S. Terry Jonathan A. Schoen
Mark E. Rentschler
Received: 19 December 2011 / Accepted: 21 February 2012 / Published online: 14 March 2012
 Springer-Verlag London Ltd 2012
Abstract The development of robotic capsule endo-
scopes (RCEs) is one avenue presently investigated by
multiple research groups to minimize invasiveness and
enhance outcomes of enteroscopic procedures. Under-
standing the biomechanical response of the small bowel to
RCEs is needed for design optimization of these devices. In
previous work, the authors developed, characterized, and
tested the migrating motor complex force sensor (MFS), a
novel sensor for quantifying the contact forces per unit of
axial length exerted by the myenteron on a solid bolus.
This work is a continuation, in which the MFS is used to
quantify the contractile strength in the small intestine
proximal, middle, and distal regions of five live porcine
models. The MFSs are surgically implanted in a generally
anesthetized animal, and force data from 5 min of dwell
time are analyzed. The mean myenteric contact force from
all porcine models and locations within the bowel is
1.9 1.0 N cm-1. Examining the results based on the
small bowel region shows a statistically significant
strengthening trend in the contractile force from proximal
to middle to distal with mean forces of 1.2 0.5,
1.9 0.9, and 2.3 1.0 N cm-1, respectively (mean
one standard deviation). Quantification of the contact force
against a solid bolus provides developers of RCEs with a
B. S. Terry (&)  M. E. Rentschler
Department of Mechanical Engineering,
University of Colorado at Boulder, 427 UCB,
1111 Engineering Drive, Boulder, CO 80303-0427, USA
e-mail: benjamin.terry@colorado.edu
M. E. Rentschler
e-mail: mark.rentschler@colorado.edu
J. A. Schoen
University of Colorado Hospital, Aurora, CO, USA
e-mail: jonathan.schoen@ucdenver.edu
valuable, experimentally derived parameter of the intralu-
minal environment.
Keywords Small intestine  Contact force  In vivo 
Migrating motor complex force sensor
Introduction
Detection, diagnosis, and treatment of pathologies within
the small bowel are challenging due to the small bowels
remote location, tortuous shape, and excessive length [1].
Intraluminal pathologies in the proximal small bowel, such
as celiac and Crohns disease, polyps, ulcers, and cancer,
are typically identified and/or treated through minimally
invasive enteroscopic procedures. Reaching the distal small
bowel, however, is difficult and requires lengthy proce-
dures performed under general anesthetization, such as
double balloon or spiral enteroscopy, or even more inva-
sive laparoscopic surgery [2]. For this reason, a new class
of untethered endoscopic device, the robotic capsule
endoscope (RCE), is being developed to further minimize
trauma and enhance the range of procedures that can be
treated with endoscopy.
Multiple research groups are developing RCEs that
obtain intraluminal movement through a variety of loco-
motion techniques [310]. Progress, however, has been
limited due in part to the difficulty of the task, but also
because models and data that characterize the intraluminal
environment are lacking. Some numerical modeling has
been developed [11]; however, with the exception of a few
studies [1218], little work has been done to physically
measure and understand the forces experienced by an RCE-
shaped solid bolus within the small bowel. To this end,
the authors initiated in previous work a comprehensive
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program to characterize the biomechanical response of the

small intestine intraluminal environment to an RCE [19].
One component of the biomechanical response is the
active force exerted by the myenteron on a solid bolus. The
longitudinal and circular muscles of the myenteron work in
tandem to create complex rhythmic contractions known as
the migrating motor complex (MMC) [20]. The circular
muscles primarily contribute to segmentation waves, which
increase peripheral resistance, slow transit, and mix intra-
luminal contents. Longitudinal muscle contractions, on the
other hand, tend to facilitate transit [21]. To the authors
knowledge, the forces generated by the longitudinal and
circular muscles against a solid bolus have not been
experimentally determined, although some theoretical
work has been developed to characterize their magnitude
and frequency [11, 22, 23]. Hence, the migrating motor
complex force sensor (MFS) was developed. The MFS is a
sensor that matches the approximate size and shape of
current RCEs. The sensor is implanted in the small bowel
of a live porcine model and measures the spatial and
temporal components of the contact force exerted by the
myenteron. In this work, we use the MFS to investigate Fig. 1 Motor complex force sensor (MFS) system with sensor
balloon segments (upper-right inset)
the myenteric contractile response to a solid bolus in the
proximal, middle, and distal regions of the small bowel of
five live porcine models. sensors were simultaneously placed in the small bowel
A complete description of the MFS system components, during each surgery. All pigs were female, with a mean
functionality, and validation are described in a previous weight of 56.5 4.6 kg. A test protocol was approved by
work [24]. Briefly, the MFS consists of an in vivo perfused the Institutional Animal Care and Use Committee [IACUC
monometer attached to an array of four torus-shaped, 2.2- protocol 87909(05)1D]. The animals were fed nothing but
cm-diameter 9 0.88-cm-wide balloon segments (Fig. 1). water and Jell-O 48 h prior to surgery and then only water
The total length of the sensing surface is 3.52 cm. Each the last 24 h to ensure that the entire length of small bowel
segment is an independent module, and additional seg- was clear of solids. The pig was generally anesthetized
ments can be added or removed, as needed. A segment with ketamine and xylazine (anesthetic and sedative,
consists of a torus-shaped custom latex balloon attached to respectively). The identification number, animal age range,
a stainless steel hub. The internal pressure and temperature weight, pre-anesthetic, region tested, and vendor are shown
of each balloon segment is measured via tubing attached to in Table 1.
the hub in vivo on the distal end, and to ex vivo transducers During each surgery, a 20-cm midline incision starting
and thermocouple data acquisition on the proximal end. about 2 cm below the xiphoid process is made in the
Pressure and temperature outputs are recorded to a com- abdominal wall. A section of the small bowel is pulled
puter via data acquisition systems. As the myenteron through the incision, and the surgeon identifies the proxi-
contracts against the surface of the balloon segments, the mal, middle, and distal regions by traversing its entire
pressure inside the segment increases. The pressure length. A 2-cm incision is made in the bowel wall, and the
increase is mapped to contact force through a series of MFS is inserted approximately 20 cm into the lumen past
previously derived correction factors and finally yields the incision (Figs. 2, 3). The incision in the bowel wall is
spatial and temporal changes in contact force from the sutured and the process repeated until all sensors are in
myenteron. place. Once the MFSs are in place, the bowel is placed
back inside the abdominal cavity, the abdomen is sutured
closed, and the animal is left untouched in the dorsal
Methods recumbent position for approximately 16 min (Fig. 4).
During this time, the vital statistics are monitored to ensure
The MFS is used to measure the myenteric contact force viability of the animal, and the MFS data are recorded.
exerted on a solid bolus in the proximal, middle, and distal Following the data acquisition, the sensors are removed
regions of five live porcine models. Up to three MFS and the animal is euthanized.

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Table 1 Identification, age, weight, pre-anesthetic, and region of the small intestine tested of the five female pigs used in the study
Pig ID Age (months) Weight (kg) Pre-anesthetic Bowel region tested Vendor

1 824 56 Atropine Middle K&S livestock

2 824 54 Atropine Proximal, middle, distal K&S livestock
3 824 53.3 None Proximal, middle, distal K&S livestock
4 824 62.3 None Middle, distal K&S livestock
5 812 57 None Middle, distal Colorado State University

Fig. 4 MFS sensors inserted into the small bowel of the porcine
model. The small bowel has been placed back inside the abdomen, the
incision is sutured closed, and the MFS data are gathered

All three of these calculations use the mean force

Fig. 2 Surgical insertion of the MFS into the middle small bowel
Fig. 3 MFS sensor fully inserted into the middle small bowel of
pig 5. Note the bowel has vigorously contracted around the sensor
Data from the experiments were used to find: (1) the
mean force per porcine model; (2) the mean force per
region location of the MFS (proximal, middle, or distal
bowel; (3) the mean force per MFS balloon segment
location.
experienced by a single MFS balloon segment while in
vivo as the base measurement. This base measurement is
denoted as F r;b;p , where r is the region in the small intestine
(proximal, middle, or distal), and b is the balloon segment
of the sensor (1 through 4), and p is the porcine model (1
through 5). Note that balloon 1 is always the trailing edge
of the sensor, and balloon 4 is the leading edge, which is
the edge that is inserted into the lumen first during surgery.
F r;b;p is calculated from data acquired from the interval of
611 min after insertion. The reason for using this interval
is that exposing the intestine to room temperature air
causes it to cool; therefore, allowing the sensors to rest in
the abdomen for 6 min after replacing the intestine and
suturing the incision enables the abdominal cavity to return
to standard body temperature.
The mean contact force from myenteric activity acting
on the MFS sensor is
1 X m X n X q
F F r;b;p 1
mnq r1 b1 p1
where m is the number of regions tested, n is the number of
balloon segments per MFS, and q is the number of pigs
tested.
The mean force per porcine model gives a general
understanding of the overall myenteric contractile strength
of the small bowel of a particular pig. It is calculated by

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1 X m X n
F pi F r;b;pi 2
mn r1 b1

where pi is the pig id (i = 1,, 5).

The mean force per region gives a general understanding
of the overall myenteric contractile strength of the proxi-
mal, middle, and distal regions of the small bowel. It is
calculated by
1 Xn X q
F ri F r ;b;p 3
nq b1 p1 i

where ri is the region of the small bowel (i = 1,, 3 for

the proximal, middle, and distal bowel respectively).
The mean force per MFS balloon segment gives the
force distribution over the length of the MFS. It is calcu-
lated by
1 X m X q central mark is the median, the blue edges of the box are the 25th and
F bi F r;bi ;p
mq r1 p1
where bi is the balloon segment (i = 1,, 4).
Results
The mean myenteric contact force, F from Eq. (1), based
on data from all MFS balloon segments, regions, and pigs,
is 1.9 1.0 N cm-1. The mean contact forces from
myenteric contractions per pig, per region, and per MFS
balloon segment are shown in Table 2. The distribution of
the data for each mean is illustrated by the box plots in
Fig. 5. As shown in the left plot of this figure, pigs 1
through 4 have force values within one standard deviation
of the mean. Pig 5, however, exhibits a significantly higher
mean force of 3.7 N cm-1. Two possible reasons for this is
Fig. 5 Box plots of myenteric force comparing the results from the
five porcine models (left; P1P5), the region of the bowel (middle),
and the MFS balloon segments (right; B1B4). On each box, the red
4 75th percentiles, the black dotted whiskers extend to the most extreme
data points not considered outliers, and outliers (red plus marks) are
plotted individually
that pig 5 was purchased from a different institution than
pigs 1 through 4 and that it could be younger (see Table 1).
Illustrated by the middle plot of Fig. 5 is an apparent
increase in contact force from the proximal to distal region
of the small bowel. A t test at the 95 % confidence level
confirms a significant difference in the mean myenteric
contact forces exerted by the proximal and distal small
bowel (p = 0.02).
The leading edge of the MFS appears to experience
lower force than the trailing edge; the differences, how-
ever, are not significant.
Discussion

Table 2 Mean contact forces from myenteric contractions

To the authors knowledge, this is the first time the contact
force exerted by the small intestine on a solid bolus has
F pi P1 1.2 been measured on multiple porcine samples and in multiple
P2 1.4
locations. The mean force value, F, is near the extreme
P3 2
of theoretical values from the literature. For example,
P4 1.7 work by Miftahof et al. finds values in the range of
P5 3.7 0.151.9 N cm-1 [10, 19, 20]. Also significant is the dis-
F ri Proximal 1.2 covery that the distal small bowel exerts 92% more con-
Middle 1.9 tractile force against the MFS than the proximal small
Distal 2.3 bowel. The reason for this is not known, though a possi-
F bi B1 2.1 bility may be that the smaller diameter of the distal bowel
B2 2.1 provides for more optimal engagement of the actin and
B3 1.9 myosin filaments, and hence higher contraction strength
B4 1.5 against the MFS, which has a fixed diameter. Future work
F pi , Mean force per porcine model from Eq. (2); F ri , mean force per will investigate contractile force as a function of bolus
region of the small intestine from Eq. (4); F bi , mean force per MFS diameter. Understanding the contact force exerted by the
balloon segment from Eq. (3) myenteron throughout the small intestine provides an

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additional characteristic that RCE designers can consider
for design optimization. Future work will investigate the
contact myenteric force of the human small intestine. The
authors have received institutional review board approval,
and work has commenced to design and create a human
biocompatible version of the device and associated test
protocol.
Acknowledgments The authors wish to acknowledge the Clinical
and Translational Research Center at the University of Colorado at
Boulder (CTRC) for assistance with the statistical analysis. This work
was funded in part by a Junior Faculty Pilot Award from the Colorado
Clinical and Translational Sciences Institute (CCTSI). This publica-
tion was supported by NIH/NCRR Colorado CTSI Grant no. UL1
RR025780. Its contents are the authors sole responsibility and do not
necessarily represent official NIH view.
Conflict of interest Drs. Schoen and Rentschler, and Mr. Terry
have no conflicts of interest or financial ties to disclose. No benefits in
any form have been or will be received from a commercial party
related directly or indirectly to the subject of this manuscript.
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