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NOSCAR 2010

NOSCAR 2010. SOLID ORGAN. SOLID ORGAN . Opportunity for clinical utilization Procedure Benefits and risks Operator Volume Timeline Obstacles for adoption Enable technology needed?. SOLID ORGAN . Opportunity for clinical utilization Procedures – Organ removal

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NOSCAR 2010

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  1. NOSCAR 2010 SOLID ORGAN

  2. SOLID ORGAN • Opportunity for clinical utilization • Procedure • Benefits and risks • Operator • Volume • Timeline • Obstacles for adoption • Enable technology needed?

  3. SOLID ORGAN • Opportunity for clinical utilization • Procedures – Organ removal • Nephrectomy, Spleenectomy, (already published) • Hepatectomy, pancreatectomy (tail), adrenalectomy… • Actually feasible with hybrid approach and use of rigid instruments • Real benefits for specimen removal and optics site on natural orifice • Mainly transvaginal • Progress to real NOTES relay on tech development like Flexible staplers and platforms • Potential use of combined approach

  4. SOLID ORGAN • Opportunity for clinical utilization • Benefits and risks –Organ removal • Benefits • Removal using natural orifices reduces abdominal wall damages of larger incisions • Natural orifices are really near to target organs • Risks • Major challenges coming of bleeding from larger vessels

  5. SOLID ORGAN • Opportunity for clinical utilization • Operator – Organ removal • Those are complex surgical procedures generally done by specialists • Keys to development • Identify the target groups • Enrol them on NOTES training

  6. SOLID ORGAN • Opportunity for clinical utilization • Timeline – Organ removal • Actually – Vaginal access • Hybrid technique with rigid instruments make it feasible and seems to be safe (nephrectomy and splenectomy) • Competes with single-site laparoscopy • Up to 3y • More use of combined approach • Reduce the use of transabdominal rigid instrumentation • New long steerable instruments ? • Magnets? • Development of flexible stapling • Specific designed to vessel control with smaller diameter • Over 3y • Platform development will allow progression toward NOTES

  7. SOLID ORGAN • Opportunity for clinical utilization • Obstacles for adoption – Organ removal • Competes with single-site surgery • Lack of large vessels control (flexible stapling) • Scaling (not so many procedures done) • Procedures done by “specialists” that are note involved with NOTES

  8. SOLID ORGAN • Opportunity for clinical utilization • Enable technology needed – Organ removal • Flexible stapling (vessels orientated) • Long steerable instruments • Magnets • NOTES surgical platforms

  9. SOLID ORGAN • Opportunity for clinical utilization • Procedures -Diagnostic and non-organ removal • Biopsy – Hepatic biopsy as killer app • Tumor ablation • Actually not on the highlight • Real benefits in competing with transabdominal approach in selected cases in-witch it can not reach the target or is ‘too risky” to do it • Enables large volume caseload • Could make transgastric approach feasible and “popular”

  10. SOLID ORGAN • Opportunity for clinical utilization • Benefits and risks –Diagnostic and non-organ removal • Benefits • Potential use for sedation / endoscopic suites • Smaller diameter scopes can be used • Enrol the gastroenterologists on this process • Real visualization / Reach the target • Risks • Potential risks of the transgastric closure

  11. SOLID ORGAN • Opportunity for clinical utilization • Operator – Diagnostic and non-organ removal • Gastroenterologists for diagnoses • Surgeons for ablation • Keys to development • Find a simple and safe way to do the gastrotomy and to close it • “10 min procedure for hepatic biopsy”

  12. SOLID ORGAN • Opportunity for clinical utilization • Timeline – Diagnostic and non-organ removal • Actually • Not seeing as a target for the ones interested on NOTES • Technology is available • Still looking for different ways to do the gastrectomy and how to close it • Up to 1-2y • Define and standardize the method (grastrotomy) • Run and maybe sponsor a bases trials • Over 3y • Adoption based on trial results

  13. SOLID ORGAN • Opportunity for clinical utilization • Obstacles for adoption – Diagnostic and non-organ removal • Lack of clinical knowledge about the safety of gastrotomy closure • A simple and fast way to do that • The established culture of image guided transcutaneous access to intra-abdominal biopsy and ablation

  14. SOLID ORGAN • Opportunity for clinical utilization • Enable technology needed – Organ removal • “Gastrotomy access kit” • To open and close • Flexible biopsy instruments for solid organs • Flexible ablation instrumentation

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