Abstract
In 1997, Professor Clayton Christensen of the Harvard Business School coined the term “disruptive innovation” to elaborate the concept that certain innovations displace established technology or ultimately create completely new technology. 1 In his thesis, he used the example of the computer hard disk as the technological example of what happens when big companies ignore competitive technology and suffer the consequences. This article from the University of California, Irvine group, has provided another possible example of this type of innovation. By creating an interface for use with widely available smartphone technology, anyone with the Endockscope (3D digitally printed support) adaptor and a battery-operated power source can capture video for endoscopic procedures with clarity for viewing urologic pathology at an affordable price that obviates the need for expensive more dedicated camera imaging systems. The investigators used the clinical environments of cystoscopy, ureteroscopy, and nephroscopy to capture images and compare with standard views obtained with conventional imaging systems. In several clinical scenarios, the Endockscope provided equal or even better images for review when directly compared. Clearly, there are many hurdles to overcome, and manufacturers of the current endoscopy equipment may be reluctant to adopt this technology. The studies need to be carried out in a larger number of subjects with more observers to validate the image quality, but the findings reported are indeed quite promising. As urologists are now being asked to see more patients with complex problems, the use of teleurology is a new frontier that should be embraced to provide higher quality and more accessible care. The Endockscope may be an entrée to providing endoscopic imaging to a wider audience both geographically and involving other medical and surgical disciplines that incorporate endoscopic video technology. Today in 2019, we may need to take the next leap by using smartphones and clouds to advance this concept.