Development and Validation of a New Generation of Flexible Endoscope for NOTES

Abstract

A new flexible access endoscope with 4 large access channels showed utility in a cadaver model-satisfying some of the requirements for performance of NOTES procedures.

Current Evidence in Gastrointestinal Surgery: Natural Orifice Translumenal Endoscopic Surgery (NOTES)

“…16,33 Current research on developing instruments to aid performing pure NOTES is underway. 34,35 For further incorporation into humans, fundamental steps and elements present in all procedures, as well as practical and technical challenges, will need to be resolved.…”

Natural orifice transtracheal evaluation of the thoracic cavity and mediastinum

“…This study aimed to evaluate the feasibility of a minimally invasive transtracheal endoscopic technique for thoracic cavity evaluation in canine models (Figs. 1,2,3,4).Two dogs were used as our study objects. For both procedures, anesthesia of canine models was induced using tiletamine hydrochloride and zolazepam hydrochloride (0.1 ml/kg Zoletil 50, Virbac, Carros; France) and xylazine hydrochloride (0.1 ml/kg Rompon, Bayer, Leverkusen; Germany) followed by maintenance with endotracheally administered isofulrance (2.5%).…”

“…Further investigations should include refinement of incision site closure, improvement of surgical instruments (small-caliber fiberoptic scope), and more reliance on incision wound sealants [1][2][3][4].…”

Robotic flexible endoscope

“…Triangulation allows the surgeon to accomplish traction and counter traction of tissue, fine dissection, and suturing and is one of the most essential concepts in laparoscopy [Wang and Meng, 2012]. Triangulation is also essential in natural orifice surgery with flexible tools [Swanstrom, 2009;Rattner and Kalloo, 2006;von Renteln, 2011]. Currently, gastroenterologists manipulate the endoscope tip including the camera and the instrument, that protrudes from the tip, to perform therapy.…”

“…[Swanstrom 2009;Thompson et al, 2009] Boston Scientific Corporation, Natick, MA, USA Nanyang University endoscopic system Cobra [Wang and Meng, 2012] [ Wang and Meng, 2012] The robotic slave of the Nanyang University (see also Section 1.5) is a cable driven end effector of round 22 mm that can be mounted on existing endoscopes. The six-DOF instruments are modeled after a simplified human arm.…”