Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Port Access Surgery (SPA): Implications of new paradigms in Minimally Invasive Surgery
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
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
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
Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Port Access Surgery (SPA): Implications of new paradigms in Minimally Invasive Surgery published by HBS Medical Limited in July 30, 2011. This report consists of 77 Pages and the price starts from US $ 3995.
