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市場調查報告書
經自然管口內視鏡手術（NOTES）以及單一切口腹腔鏡手術（SPA）：新典範於低侵入性手術上的影響
Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Port Access Surgery (SPA): Implications of new paradigms in Minimally Invasive Surgery
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經自然管口內視鏡手術（NOTES）以及單一切口腹腔鏡手術（SPA）：新典範於低侵入性手術上的影響 是由出版商HBS Medical Limited在2011年07月所出版的。
這份英文市場調查報告書包含77 Pages 價格從美金3995起跳。
近幾年，經自然管口內視鏡手術（NOTES）與單一切口腹腔鏡手術（SPA）兩項新的手術方式受到關注。NOTES以及SPA皆為改善美容手術，NOTES具可排除創傷的感染和腹壁疝氣的發病等，提供腹腔鏡手術的許多優點。SPA也同樣具有可抑制手術疤痕，並加快恢復等的優點。
本報告，檢證該兩項手術的應用與課題，並彙整技術障礙與克服的解決對策、將來的發展性等，由下列摘要形式闡述。
報告摘要
簡介
- 歷史概要與背景
- 現在方法的優點
- NOTES與SPA的課題
方法與應用
NOTES
SPA
- 應用
- 膽囊切除手術
- 盲腸切除手術
- 臍旁・臍切口疝氣修補
- 腹股溝疝氣修補
- 實驗性階段的處置
- 腹壁疝氣修補
- 胃切除手術
- 卵巢摘除
- 子宮摘除
- 腎摘除手術
NOTES與SPA的方法與應用概要
- 阻礙與潛在解決對策
- 阻礙：機器的三角點
- 阻礙：通路的閉鎖
- 閉鎖：腹腔內輸氣
技術應用與發展
- Access Port
- 攝影解決方案
- 手持儀器
- NOTES/SPA用多任務工作平台
- 機器人解決方案
將來方向性
SPA/NOTES
- 孔的削減、複合方法：將來展望
- 市場的策略評價與對產品製造業者的影響
圖表
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
- Challenges for NOTES and SPA
- Notes Challenges
- Risk of infection
- Peritoneal access
- Visceral closure
- SPA challenges
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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