TOP　＞　Introduction

INTRODUCTION

For the past few decades, physicians have employed in "minimally invasive treatments," which may provide less operative trauma, less pain, faster recovery, and better cosmesis for patients. Laparoscopic surgery is one of the mainstreams in this field.

Most recently, Natural Orifice Translumenal Endoscopy Surgery (NOTES) was introduced in the United States. It is a totally new surgical technique that a flexible endoscope passes through a natural orifice (mouth, anus, etc.) then through an internal incision in the stomach, vagina or colon, to perform abdominal operations. NOTES has been accepted as the newest frontier in minimally invasive surgery. Performing surgery without any external incisions or scars was advocated as the next major paradigm shift.

During the basic and pre-clinical phase of NOTES, however, researchers have faced numerous difficulties in the use of flexible GI endoscope and its instruments in larger and more complicated peritoneal cavity. As a result, clinical use of NOTES has been still limited in several institutions. Extended research and development need to be conducted.

At Osaka University, we formed a multi-disciplinary team in 2006 and initiated basic research of NOTES. Since early August 2008, we have performed transvaginal NOTES partial gastrectomy for 8 patients with gastric submucosal tumors. Our challenge was highly recognized as not only Japan's first human NOTES series for therapeutic purpose, but also as the world's first partial gastrectomy using NOTES technique. Our patients benefit from NOTES by experiencing virtually “no pain” and rapid recovery after surgery. Yet, throughout the basic and clinical steps, we have encountered numerous technical challenges, where positive integration of flexible GI endoscopy and laparoscopy was considered indispensable.

In the development for therapeutic instruments, diverse and high level of manufacturing skill is necessary along with the knowledge and information from the researchers. If we are going to convert our ideas into a commercial reality, we also need to cooperate with major industries with mature know-how. In 2008, we formed an R & D consortium called “project ENGINE” with domestic industries to develop necessary instruments for this future integration. ENGINE stands for “Endeavor for Next Generation of INterventional Endoscopy.” Currently, this industry-academia collaboration consortium, ENGINE consists of over 20 surgeons and GI doctors from Osaka University and 8 domestic industries.

In this difficult business climate, many industries cannot demonstrate their potentials. Companies around the world are seeking business opportunities to develop and manufacture medical instruments for the next generation treatment as NOTES. With our team of highly motivated doctors towards this future treatment and highly spirited engineers to develop next generation instruments, we truly believe we can bring something out to the world starting out from this ENGINE!!

Kiyokazu Nakajima, MD, FACS
Department of Surgery
Osaka University Graduate School of Medicine, Osaka, Japan