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経管腔的内視鏡手術(NOTES)および単孔式手術(SPA):低侵襲性手術における新たなパラダイムの影響

Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Port Access Surgery (SPA): Implications of New Paradigms in Minimally Invasive Surgery

発行 HBS Medical Limited 商品コード 225668
出版日 ページ情報 英文 77 Pages
納期: 即日から翌営業日
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経管腔的内視鏡手術(NOTES)および単孔式手術(SPA):低侵襲性手術における新たなパラダイムの影響 Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Port Access Surgery (SPA): Implications of New Paradigms in Minimally Invasive Surgery
出版日: 2011年07月30日 ページ情報: 英文 77 Pages
概要

近年、経管腔的内視鏡手術(NOTES)と単孔式手術(SPA)という2つの新しい手術方式に関心が寄せられています。NOTESおよびSPAは共に美容手術を改善するもので、NOTESは創傷からの感染や腹壁瘢痕ヘルニアの発症を排除するなど、腹腔鏡下手術の多くのメリットを提供するものです。SPAについても同様、手術痕を抑え、回復を早くするなどのメリットがあります。

当レポートでは、これら2つの手技の応用と課題について検証し、技術的障壁と克服するための解決策、将来的発展性などをまとめ、概略下記の構成で取り上げております。

エグゼクティブサマリー

イントロダクション

  • 歴史的概要と背景
  • 現在のアプローチによるメリット
    • NOTES
    • SPA
  • NOTESとSPAの課題
    • NOTESの課題
      • 感染リスク
      • 腹膜アクセス
      • 内臓閉鎖
    • SPAの課題
      • コスト
      • 手術時間

アプローチと応用

NOTES

  • アプローチ
    • 経膣アクセス
    • 経胃アクセス
    • 経大腸/経鼻アクセス

SPA

  • 応用
    • 胆嚢弛緩
    • 虫垂切除術
    • 臍傍・切開臍ヘルニア修復
    • 鼠径ヘルニア
  • 実験的段階の処置
    • 腹壁ヘルニア
    • 胃切除術
    • 卵巣摘出
    • 子宮摘出
    • 腎摘出術

NOTESとSPAのアプローチと応用概要

  • 障壁と潜在的解決策
    • 障壁:機器の三角点
    • 障壁:アクセスサイトの閉鎖
    • 閉鎖:腹腔内送気

技術的応用と発展

  • アクセスポート
    • 特殊ポート
    • アクセスポートサマリー
  • カメラソリューション
  • ハンドインスツルメント
  • NOTES/SPA用のマルチタスクプラットフォーム
  • ロボティックソリューション

将来の方向性

SPA/NOTES

  • 孔の削減、ハイブリッドアプローチ:将来的展望
  • 市場の戦略的評価と製品製造業者への影響

図表

目次

Abstract

Description

In recent years there has been an increasing amount of interest and focus on two new approaches in surgery, Single Port Access Surgery (SPA) and Natural Transluminal Endoscopic Surgery (NOTES). Both NOTES and SPA also have the advantage of an improvement in cosmesis It is also believed that NOTES could offer all the benefits of laparoscopic surgery with the included advantage of not requiring any abdominal wall incisions and therefore, eliminating the possibility of wound infection and incisional hernias. Other proposed benefits of SPA surgery are similar to those proposed for NOTES surgery, these being reduced post operative pain, faster recovery, and a reduced need for analgesia; at present evidence to support these suggested benefits is limited.

This reports examines the applications and challenges of both of these novel approaches to surgery and investigates the technological barriers, and some of the solutions that have been developed to overcome these barriers including access ports, camera solutions, hand instruments, multi-tasking platforms and robotic solutions.

The report also examines the future directions that minimally invasive surgery may take and the implications of this for medical device manufacturers.

Table of Contents

Executive summary

Introduction

  • Historical context and background
  • Advantages over current approaches
    • NOTES
    • SPA
  • Challenges for NOTES and SPA
    • Notes Challenges
      • Risk of infection
      • Peritoneal access
      • Visceral closure
    • SPA challenges
      • Costs
      • Operating time

Approaches and applications:

NOTES

  • Approaches
    • Transvaginal access
    • Transgastric access
    • Transcolonic / Transanal access

SPA

  • Applications
    • Cholecystecomy
    • Appendectomy
    • Paraumbilical and incisional umbilical hernia repair
    • Inguinal hernia repair
    • Experimental phase procedures:
    • Ventral hernia repair
    • Sleeve gastrectomy
    • Oophorectomy
    • Hysterectomy
    • Nephrectomy

Overview NOTES and SPA Approaches and Applications.

  • Obstacles and potential solutions
    • Obstacle - Instrument Triangulation (SPA and NOTES):
      • Solution 1 (SPA) change trocar to allow better manipulation
      • Solution 2 (SPA) use low profile trocars, reduce number of trocars,
      • Solution 3 (SPA) use specially adapted trocars
      • Solution 4 (SPA & NOTES) Articulating instruments
      • Solution 5 - (SPA & NOTES) Curved instruments
      • Solution 6 - choice of camera
      • Solution 7 - Magnetic Anchoring Guidance Systems (MAGS)
      • Solution 8 Robotic platforms
    • Obstacle - Closure of the access site NOTES
      • Solution 1 - No closure approach
      • Solution 2 - Submucosal endoscopy with mucosal flap safety valve
      • Solution 3 - Endoclips
      • Solution 4 - Endoloops
      • Solution 5 - The Queens closure
      • Solution 6 - Endoscopic suturing devices
      • Solution 7 - Occlutech Occluder
      • Solution 8 - Over the scope clip
      • Solution 9 - T-tag Tissue anchors
      • Solution 10 - RD 180
      • Solution 11 - PEG tubes
      • Solution 12 - Tri-Staple
      • Solution 13 - Tissue Glue
      • Solution 14 - Omentplasty
    • Obstacle - Peritoneal Insufflation NOTES
      • Solution 1 - laparoscopic / peritoneal insufflators Obstacle - Training NOTES & SPA
      • Solution - Euro-NOTES / NOSCAR

Technological applications and development

  • Access Ports
    • Specialised ports
      • Tri-Port & Quad-Port - Advanced Surgical Concepts /
      • Olympus
      • SILS Port - Covidien
      • Airseal System - Surgiquest
      • Octo Port - Dalim Surgnet
      • SSL Access System - Ethicon Endo Surgery
      • Gelpoint - Applied Medical
      • X-Cone / ENDOcone - Karl Storz
    • Access Ports Summary
      • Low profile trocars
      • Homemade port for SPA
  • Camera Solutions
    • Modified laparoscopes
    • EndoEYE - Olympus / Eyemax CCD Endoscope - Richard Wolf
    • Ideal Eyes HD, Stryker Magnetic camera guidance
  • Hand instruments
    • Curved instruments
    • Articulated instruments
    • Radius Surgical System - Tuebingen Scientific
    • Semi-Robotic hand instruments
    • Retractors
  • Multi-tasking platforms for NOTES/ SPA
  • Robotic solutions
    • Da Vinci Robot
    • Robotic camera manipulators
    • Miniature robots for NOTES

Future directions

SPA / NOTES:

  • Reduced Port Surgery, hybrid approach - Is this the future?
  • Strategic evaluation of market and implications for product manufacturers

Table of tables

  • Table 1: Advantages and Disadvantages - SPA and NOTES
  • Table 2: Closure of access sites: NOTES
  • Table 3: Technical applications and development a summary: specialized ports
  • Table 4: Technical applications and development a summary: other access port solutions
  • Table 5: Technical applications and development a summary: camera solutions
  • Table 6: Technical applications and development a summary: hand instruments
  • Table 7. Technological applications and developments a summary: robotic solutions

Table of figures

  • Figure 1 - Mickey mouse configuration
  • Figure 2: current procedures performed using SPA Surgery
  • Figure 3: Using three trocars for SPA
  • Figure 4: Standard rigid laparoscope
  • Figure 5: Flexible articulating laparoscope
  • Figure 6: Curved instruments
  • Figure 7: MAGS platform
  • Figure 8: TriPort - Advanced Surgical Concepts
  • Figure 9: SILS Port - Covidien
  • Figure 10: Octoport Dalim Surgnet
  • Figure 11: Gelpoint - Applied Medical
  • Figure 12: X-Cone by Karl Storz
  • Figure 13: ENDOcone by Karl Storz
  • Figure 14: Real Hand High Dexterity Instrument
  • Figure 15: Laparo-Angle Cambridge Endo
  • Figure 16: EndoGrab - Visual Ports Ltd
  • Figure 17: TransPort Multi-Lumen Operating System - USGI
  • Figure 18: In vivo imaging robot
  • Figure 19: Millennium Research Group - Projections for SPA revenue
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