Surgical procedures completely different from conventional surgical approaches began to be developed to improve minimally invasive surgery. New devices are required for new surgical procedures. Domestic companies in Japa...Surgical procedures completely different from conventional surgical approaches began to be developed to improve minimally invasive surgery. New devices are required for new surgical procedures. Domestic companies in Japan encounter extremely difficult tasks when developing such devices, receiving regulatory approval, initiating commercialization, and ensuring their absolute safety. With the focus on high-speed lavage of the gastrointestinal tract in multipiercing laparoscopic and endoscopic cooperative surgery, this paper explains how to develop a micro-nano bubble generator that satisfies the above requirements and regulations for new devices.
This paper describes the potential role and limitations of current three-dimensional (3D) virtual reality (VR), augmented reality (AR), and holography for image-guided surgery. We developed a new surgical spatial navigat...This paper describes the potential role and limitations of current three-dimensional (3D) virtual reality (VR), augmented reality (AR), and holography for image-guided surgery. We developed a new surgical spatial navigation system using VR, AR, and virtual holography. An interactive stereo display is used to view the interactions between the surgeon and stereo images of the patient’s anatomy depicted on the display by tracking the surgeon’s head and hand/arm positions. Sensing the surgeon’s head position creates motion parallax information, an immersive depth cue that can be added to the binocular parallax already present in the display. The beneficial applications of VR/AR devices (head-mounted devices, 3D tablets, and motion sensors) are also discussed. They allow the user to manipulate the spatial attributes of VR, which can enhance spatial reasoning and AR.
The Da Vinci Surgical System was developed to overcome some of the disadvantages of conventional endoscopic surgery. We have been performing robotic gastrectomy or esophagectomy in patients with resectable gastric or eso...The Da Vinci Surgical System was developed to overcome some of the disadvantages of conventional endoscopic surgery. We have been performing robotic gastrectomy or esophagectomy in patients with resectable gastric or esophageal cancer who agreed to uninsured use of the robot since 2009, resulting in reduced postoperative local complications including pancreatic fistula following gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. Moreover, the greater the extent of resection and lymph node dissection, the greater this effect, suggesting that the robot may be more beneficial for advanced cancer than for early cancer. In the meantime, there have been a considerable number of reports, mostly focusing on early cancer, that the use of the robot may reduce cost-effectiveness in comparison with the conventional laparoscopic or thoracoscopic approach. Thus, since the beginning of October 2014, we have been conducting a multiinstitutional, single-arm prospective study designed to determine the impact of robotic assistance, which has been approved as advanced medical technology (senshiniryo) by the Japanese Ministry of Health, Labor and Welfare, on the outcomes after minimally invasive radical gastrectomy to treat resectable gastric cancer, with a focus on postoperative complications, long-term outcomes, and cost.
The clinical application of natural orifice translumenal endoscopic surgery (NOTES) began in 2007, and several thousand patients worldwide have undergone the technique. In this review, we summarize and highlight the curr...The clinical application of natural orifice translumenal endoscopic surgery (NOTES) began in 2007, and several thousand patients worldwide have undergone the technique. In this review, we summarize and highlight the current status and future directions of NOTES. The most common procedures are cholecystectomy and appendectomy, mainly performed as hybrid NOTES through the transvaginal route. In addition, direct-target NOTES such as per oral endoscopic myotomy (POEM) or transanal total mesorectal excision has spread rapidly, because it allows access to the operative field without injuring healthy visceral organs. In Japan, a clinical registration system was established, and clinical applications are carried out safely. NOTES performed in Japan is characterized by procedures requiring extensive techniques of endoscopic treatment such as endoscopic full-thickness resection, POEM, and the submucosal tunnel method. It will be necessary to develop instruments and determine social needs to achieve pure NOTES. It will also be necessary to determine the significance of reducing surgical wounds on the body surface. Although much work is still needed to refine the techniques for NOTES, it appears to be developing as a new minimally invasive form of surgical and endoscopic treatment.
We define needlescopic surgery (NS) as endoscopic surgery performed with 2- to 3-mm needlescopic instruments, and it has received attention as a form of reduced-port surgery. Reports on NS have been published since 1998,...We define needlescopic surgery (NS) as endoscopic surgery performed with 2- to 3-mm needlescopic instruments, and it has received attention as a form of reduced-port surgery. Reports on NS have been published since 1998, and their number has gradually increased. A Japanese study group called the “Needlescopic Surgery Meeting” was established in October 2000. The advantages of NS are improved cosmetic results and reduced postoperative pain. Although the cosmetic results of NS are inferior to those of single-incision endoscopic surgery, the creation of an operative field is similar to that using the conventional method, and NS involves less stress on surgeons. In the comparison of postoperative pain among conventional, single-incision, and needlescopic techniques, the amount of postoperative analgesics required after the needlescopic technique is significantly (p＜0.001) less than that after the other techniques. The disadvantages of NS are the poorer image quality of the needlescope, difficulty in grasping due to the fine shaft of the instruments, and difficulty in creating the operative field. If we understand the specific details of needlescopic instruments and endeavor to use them properly to avoid intra- and postoperative complications, NS will become more advanced in cooperation with single-incision endoscopic surgery.
Recently, a new concept of laparoscopic surgery called “reduced-port surgery,” which aims reducing abdominal wall destruction, has been under development. There is as yet no definitive definition for this new surgery, bu...Recently, a new concept of laparoscopic surgery called “reduced-port surgery,” which aims reducing abdominal wall destruction, has been under development. There is as yet no definitive definition for this new surgery, but in this article, we define it as aiming at less invasiveness than conventional laparoscopic surgery by reducing abdominal wall destruction. Several reported meta-analyses concluded that single-port cholecystectomy required longer operation times and had better cosmetic outcomes but that there were no differences in postoperative pain, hospital stays, and complication rates. A search of PubMed using the key words “reduced-port surgery” yielded 96 papers, with the number increasing each year, and half of those were reports from Japan. The future of reduced-port surgery is promising, and the use of this technique will spread and develop in tandem with patient demand and advances in surgical instruments. In particular, advances in instruments including robotics are vital, and contributions by Japanese surgeons and engineers are anticipated. This surgical technique may be ideal for resolving problems of safety, education, cost, curability, etc.
Laparoscopic wedge resections are performed for the local resection of gastric submucosal tumors. Recently, laparoscopic and endoscopic cooperative surgery (LECS) has been performed for submucosal tumor resection, indepe...Laparoscopic wedge resections are performed for the local resection of gastric submucosal tumors. Recently, laparoscopic and endoscopic cooperative surgery (LECS) has been performed for submucosal tumor resection, independent of tumor location and size. The LECS procedure can be performed safely with adequate incision lines. Nonexposed endoscopic wall-inversion (NEWS) and the combination of laparascopic and endoscopic approaches to neoplasia with the nonexposure technique (CLEAN-NET) were reported as new procedures in laparoscopy and endoscopy without perforation of the stomach to avoid tumor seeding. In the classic LECS procedure, both mucosal and submucosal layers around the tumor are dissected circumferentially using endoscopic submucosal dissection. Subsequently, the seromuscular layer is dissected laparoscopically. The submucosal tumor is then exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device. In the NEWS procedure, the seromuscular layer is dissected circumferentially and sutured under laparoscopy, and the mucosubmucosal layer is incised circumferentially under endoscopy. These LECS procedures are applicable for submucosal tumor resection such as gastrointestinal stromal tumors and could be applicable for gastric cancer surgery. Cooperation between surgeons and endoscopists is required to perform and develop LECS procedures.