The Future of Laparoscopy: Single Incision, NOTES and Robots

Article preview from Start Up - July, 2010

The skill sets of laparoscopy, endoscopy, robotics and even interventional cardiology are all converging to create least invasive surgeries that take laparoscopy as a point of departure but change how surgeons access the abdominal cavity. Start-ups are innovating to supply the new surgical instruments.

The Future of Laparoscopy: Single Incision, NOTES and Robots

Article preview from Start Up - July, 2010

The skill sets of laparoscopy, endoscopy, robotics and even interventional cardiology are all converging to create the ultimate in least invasive surgeries. Start-ups are innovating to supply the new surgical instruments.

For surgeons, it has always been a necessary evil to make skin incisions on the abdomen to access the peritoneal cavity and surgically treat the pathologies of internal organs. The ideal, of course, would be if surgeons could root out disease without cutting into patients' bellies at all. Physicians have been steadily making progress toward that goal since the 1980s, when the introduction of laparoscopic tools allowed surgery to take a giant leap forward. Now physicians routinely access the abdominal cavity using several "keyhole" incisions, rather than using one large incision. But in the two decades since the advent of laparoscopy, surgeons have only inched closer to that ultimate ideal – incisionless surgery.

The number and size of ports of entry have diminished over the years, and a small number of innovative surgeons have even succeeded in performing truly scarless surgery using a NOTES approach. NOTES (natural orifice translumenal endoscopic surgery) is an experimental alternative to conventional surgery that allows surgeons to access the peritoneal cavity through the mouth, the rectum, or the vagina to perform surgery. To date, there have been several reports of successful NOTES procedures in humans, including transgastric and transvaginal gallbladder removal procedures (cholecystectomy); transgastric appendectomies; and incisionless cancer staging procedures, as well as laparoscopic-assisted NOTES versions of hernia repair, colon resections, liver biopsies, nephrectomies and other general surgery procedures.

However, NOTES remains just out of reach for all but a handful of highly skilled surgeons, because there is currently a lack of enabling technologies, such as flexible, articulating and far-reaching tools, that have the force transmission required to mimic the direct power that comes from a surgeon's hands when cutting, grasping, retracting and closing tissue. Ovesco Endoscopy AG, [2010900171] profiled here, hopes to remedy that last lack with an over-the-scope clip for surgical site closure. NOTES may always represent a smaller market than laparoscopy and its iterations, because using natural orifices to access the peritoneal cavity requires skills in flexible endoscopy that few general surgeons have. Most surgeons are adept with rigid endoscopes, but flexible endoscopy is the domain of gastroenterologists and a very small number of general surgeons.

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Companies mentioned in this article:

Ovesco Endoscopy AG,


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