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Special report: Endoscopy, doing more for less

by Lauren Dubinsky, Senior Reporter | March 18, 2014
Endoscopy International Day of Radiology 2012
From the March 2014 issue of HealthCare Business News magazine

POEM was also developed in Japan, in 2008, a little more than a decade after ESD. For POEM, the patient is put under general anesthesia and the surgeon uses an endoscope to go down the esophagus toward the esophageal gastric junction. The lower esophageal sphincter is then cut, which allows patients with Achalasia to ingest food more easily.

“There is a lot of technology and a lot of energy being spent toward being able to take these lesions out less invasively,” says David Pierce, senior vice president and president of the endoscopy division at Boston Scientific.

Olympus has a series of electrosurgical knives that enable smooth and efficient cutting during ESD including DualKnife, Hook- Knife and ITKnife2. They also have a couple of supporting devices called Coagrasper and EndoLifter.

Even though both procedures have been around for a while in Japan, they are just starting to emerge in the U.S. “That’s the typical trend, is that a lot of these techniques are honed and pioneered mainly in Japan and sometimes in Europe and then they’re brought over here,” says Ross.

Another procedure revolutionizing minimally invasive surgery is minilaparoscopy. Historically, conventional laparoscopy instruments were about 10 millimeters in length and overtime they shrunk to 5 millimeters, but KARL STORZ Endoscopy-America Inc. managed to create miniature laparoscopic instruments that only require a 3 millimeter incision.

“Development of minilaparoscopy technologies is being driven, in part, by the patient’s desire for outcomes that are not only successful, but also offer improved cosmesis,” says Susan Jaffy Marx, director of marketing communications at KARL STORZ.

The set includes HOPKINS II laparoscopes, CLICKLINE scissors and dissecting and grasping forceps, ergonomic and light trocars, electrodes for coagulation, stable KOH needle holders and instruments for suction and irrigation.

Specialties once dominated by traditional laparoscopic techniques including gynecological, general, pediatric, urologic, bariatric, thoracic and colorectal surgery, are now adopting minilaparoscopy techniques, says Marx.

Last year, Dr. Ceana Nezhat, a gynecologic surgeon and program director at Northside Hospital in Atlanta, started using the instruments to treat patients with endometriosis. “My personal opinion is that this is a definite tremendous advancement in performing major surgeries through a small incision,” he says.

When he used to perform procedures involving mesh embedded in organs with conventional methods, he says the results were unacceptable. He would have to cut through the mesh and undo what had been done and redo it again. But since the minilaparoscopy instruments are so small in diameter, he can go through the mesh without the need to undo and redo prior procedures.

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