Special Interview

Potential of Endoscopic Surgery

surgery was “the greater the wound, the greater the surgeon”,
with patients unable to get up for a week due to pain from the
wound. In contrast, in the case of a simple benign procedure,
patients who have undergone modern endoscopic surgery can
be up and about ready to return home the following day.
Honorary Director, National Hospital Organization Tokyo Medical Center The widespread adoption of endoscopic surgery began after
Member of the New Strategy Promotion Special Investigating Committee,
Strategic Headquarters for the Promotion of an Advanced Information and
it built up a reputation for success in surgery for cholelithiasis
Telecommunications Network Society (gallstone disease), a non-malignant condition. I had my eyes
Auditor, Japan Society for Endoscopic Surgery
opened to the technique at a video session on gallbladder

Sumio Matsumoto removal during an international conference on gastrointestinal

surgery in Toronto in 1989, and only a year later in 1990 I
1973: Graduated from Keio University School of Medicine performed my first local excision of an early gastric carcinoma.
1973: Trainee Surgeon, Keio University School of Medicine
1980: Surgeon, National Hospital Organization Kanagawa Hospital In 1991, I performed the first inguinal hernia operation in Japan.
1982: Assistant Professor in Surgery, Nagoya Health University School of Medicine In those days, many surgeons were unfamiliar with laparoscopic
1984: Assistant Professor in Surgery, Fujita Health University College School of
Medicine surgery, with many preferring to use the mesh plug insertion
1990: Associate Professor of Surgery, Fujita Health University School of Medicine procedure which has a simpler frontal approach, and therefore
1993: Professor of Surgery, Fujita Health University School of Medicine
interest temporarily died down in the laparoscopic repair of
2000: Director, Banbuntane Hotokukai Hospital, No. 2 Teaching Hospital, Fujita
Health University inguinal hernias, a surgical technique that is difficult to learn.
2005: Director, National Hospital Organization Tokyo Medical Center Nevertheless, the simpler technique doesn’t sufficiently reinforce
2014: Honorary Director, National Hospital Organization Tokyo Medical Center
the area where the hernia occurred, resulting in relapses and
Notable involvement in academic associations, etc. other negative outcomes. This led to a recognition of the
Member of the New Strategy Promotion Special Investigating Committee,
benefits of using laparoscopic surgery, which enables the
Strategic Headquarters for the Promotion of an Advanced Information and
Telecommunications Network Society; Auditor, Japan Society for Endoscopic surgeon to directly observe what is happening as they work and
Surgery; former Executive Director, Japan Hospital Association; chairman of the thereby to properly reinforce the site of the hernia and prevent
ethics committee, member of the social insurance medical care fee committee,
and member of Gaihoren at the Japan Hospital Association; chairman of the a relapse, and I have been aware of a rising number of surgeons
25th Conference of the Japan Society for Endoscopic Surgery; chairman of the wanting to learn the technique since around 2012. A survey by
62nd Conference of National Hospitals; Administrator, 28th Conference of the
Japanese Research Society of Surgical Cancer Immunology; Advisor, Japan
the Japan Society for Endoscopic Surgery showed a rise in the
Laparoscopic Hernia Surgery Society, and other positions relapse rate over the last two years. I suspect this may be the
result of procedures not being performed appropriately because
of the large number of surgeons adopting the technique for the
first time. I would like to take advantage of mechanisms such
Endoscopic surgery has made dramatic advances in recent as skill qualification examinations to promulgate appropriate
years, with operations such as gallbladder removal having practices.
become standard procedures. We spoke to Sumio Matsumoto, In the case of operations on malignant tissue, laparoscopic
Honorary Director of the Tokyo Medical Center, about the excision of colon cancers was first reported in 1993, with
potential for further advances in this field. operations such as gastrectomies and esophagectomies
(respectively, removal of part of the stomach or esophagus)
Q: What has endoscopic surgery brought to the field of surgical now in the process of becoming standard procedures in
treatments? recognition of the reduced stress they impose on the patient. In
fact, laparoscopic surgery has become widely used for cancer
A: The biggest difference from open abdominal surgery is that surgery at high-volume centers (clinics that operate on a large
endoscopic surgery is a minimally invasive therapy. By enabling number of cases) that perform a variety of difficult surgical
patients to return quickly to their daily lives, this has reduced procedures.
losses on both an economic and a social level. When I first
became a surgeon about 40 years ago, the attitude of abdominal

36 The Olympus Medical Business

Q: How will minimally invasive therapy become more widely Q: How do you see the technology of surgical endoscopy
adopted in the future? developing in the future?

A: When you look at the current situation, where laparoscopic A: Olympus’s 3D endoscope looks like an extremely promising
surgery is desirable for both surgeons and patients, I believe it instrument. For example, delicate tasks such as suturing are
will spread into new fields, such as cancer of the larynx and difficult for beginners to perform using a 2D image because
pharynx in ear, nose, and throat (ENT); cancer of the uterus in it is so hard to get good depth perception, and it has been
gynecology; and cardiac bypass surgery. demonstrated that 3D images that provide a sense of depth
However, endoscopic surgery is a difficult technique to learn make a significant difference by shortening the time taken for
and having it more widely adopted as a safer surgical procedure such tasks.
requires robust mechanisms to be put in place through the skills Robotic assisted surgery, meanwhile, not only reduces the
certification program that commenced in 2005 by the Japan physical workload of the surgeon, it is also said to shorten
Society for Endoscopic Surgery. The skills certification program the time taken for surgical training compared to laparoscopic
allocates 60 points to generic skills such as the use of forceps surgery. Prostatectomies using the American-made Da Vinci
and electrosurgical knives during general endoscopic surgery, system received insurance cover approval in 2012, and at
and 40 points to the various organs, with the two independent the Tokyo Medical Center we have already performed six
examiners needing to award a total of 70 points or more to robotically assisted gastrectomies. Since this uses two cockpits,
achieve a pass. However, certification does more than just with two surgeons working alternately to perform the operation,
qualify the surgeon to use the technique, rather it is intended it enables a new relationship unlike the surgeon and assistant
to assess whether they have reached the level needed to be a relationship used for open abdominal surgery.
supervising surgeon. The pass rate of 30% to 40% means that In the future, I would like to see Olympus developing the sort of
certification is very difficult to obtain by the standards of such products that only you could produce. In terms of what surgeons
industry qualifications. like myself are looking for, numerous research institutions are
working on developments such as robot arms that can perform
Q: Will use of endoscopic surgery also spread to emerging automatic suturing or ligation, or forceps that provide tactile
nations? feedback, and I look forward to these being commercialized.
I am also a member of the Cabinet Office’s IT Promotion
A: Surgeons from emerging nations who have acquired skills Strategy Committee, and speaking in that capacity there is a
through study in nations with well-developed medical practices need for the development of instruments and services that
are using endoscopic surgery in their home countries. There is a
training facility for endoscopic surgery in Taiwan that is headed
by a French surgeon, and I have visited there to teach about
inguinal hernia repair operations. I noted that they even had
people coming to train there from Australia.
I understand that Olympus has opened training facilities in
China at Beijing, Shanghai, and Guangzhou. I have been aware
of young surgeons from places such as South America and
Central Asia coming to train in Japan over the last 30 years,
and with endoscopic surgery likely to become routine in these
countries as they become more developed, I believe that
training institutions like these that include endoscopic surgery as
well as gastrointestinal endoscopy will be needed all over the
world in the future.

The Olympus Medical Business 37

incorporate advances in IT. For example, capsule endoscopy is Surgery with which I was involved in 2012, we set up the first
used to perform examinations by having a receiver collect data plaza for medicine-industry collaboration in the form of an
from a capsule inside the patient’s body. Shouldn’t it also be exhibition space where surgeons, researchers, and companies
possible to have a service that sends this data via a network to a exchanged views face to face. Currently, there are numerous
facility with diagnostic capabilities, and then receives a prompt initiatives underway for strengthening collaboration between
result? Because this only requires the patient to swallow the medicine and industry, including the “Monozukuri Commons”
capsule, it would enable examinations to be carried out even in which provides a forum where companies and physicians can
places that lack medical infrastructure, such as clinics that do meet at different places. The Japan Society for Endoscopic
not have an endoscopy specialist. Surgery is also working on a variety of projects.
Furthermore, work is also progressing on systems that get As I believe there would be no advances in endoscopic surgery
patients to fill out a questionnaire on a PC or tablet computer were it not for collaboration between medicine and industry,
while they wait at an outpatient clinic, thereby making their increasing the number of such forums in the future is significant
electronic medical records immediately available. This enables for all parts of the medical equipment industry.
doctors to quickly identify the suspected ailment when they I have myself been involved in the development of a variety
carry out a diagnosis, and deal promptly with things like getting of products since being approached by an Olympus engineer
tests done. Such systems are close to being realized and should when attending a conference in the early 1990s. While some
be ready by the time of the Tokyo Olympics. of these developments never reached the market, I believe that
Using IT in this way to improve services is also vital when you getting doctors and vendor company engineers facing in the
consider the trend toward an aging population and lower birth same direction and engaging in debate is vitally important for
rate, and I believe Olympus needs to produce systems that are the progress of medical technology. A good example of this,
compatible with such an environment. I believe, are the recently released THUNDERBEAT energy
devices, world-first products that combine bipolar high-
Q: What benefits have collaboration between medicine and frequency current with ultrasound.
industry brought to surgical treatments, and what do you see as In this way, I am aware that Olympus is striving to identify
the future possibilities and challenges? diverse market needs through discussion with doctors like
myself. I look forward to you continuing to develop products
A: I believe in the importance of collaboration between that satisfy market needs.
medicine and industry. At the Japan Society for Endoscopic
Q: Finally, please tell us your views if there is anything you
would like from Olympus in the future?

A: While Olympus medical instruments such as gastrointestinal

endoscopes and laparoscopes tend to be completely adequate
in a technical sense, I believe there is room for further
enhancements by incorporating technologies from outside
medicine. The use of wireless technologies such as Bluetooth
to eliminate the need for cables in endoscopes, for example,
would make them more maneuverable and convenient to use.
Similarly, progress on shifting to the cloud servers used for
filing endoscope images at each institution would enhance
convenience and reduce costs at hospitals.
As a Japanese manufacturer of medical instruments, Olympus
is recognized as one of the few companies with the technology
to take on the world. In the future, I look forward to you also
utilizing the latest technologies from outside the company to
further improve your products and services.

38 The Olympus Medical Business

Surgical Products

Engineer’s Interview:
This is How we Make Progress on Minimally Invasive Therapy

invasive therapy and I believe this has lowered the barriers

to people undergoing surgery. It has shortened the month-
long hospital stays associated with laparotomies, for example.
Depending on the nature of the case, it has become a matter
Manager, Energy 1 Group, Therapeutic Products Department,
Medical Product Development Division 2, Olympus Corporation. of course for patients to be back to their normal lives one week

Eiji Murakami
after their operation.

Technology Advances in Collaboration

with Doctors
Q: I understand that the field of endoscopic surgery has made
One of the two valuable methodologies delivered by the considerable progress since the early days?
Olympus medical business, minimally invasive therapy reduces A: Operating times have shortened and the stress on patients has
the stress on the patient and enhances their subsequent quality been reduced. Gastric resections, for example, typically used to
of life (QOL). The company’s THUNDERBEAT electrosurgical take five or six hours, whereas now they are often completed
devices used in operating rooms were also developed with in three to four hours. While this is in a large part thanks to
this objective in mind. In this article, Eiji Murakami, who has advances in doctors’ skills, I believe that the improvements to
had a long involvement in the development of endotherapy medical equipments have also played a part.
devices and surgical products, including responsibility for the Q: In other words, you made advances in tandem with doctors?
THUNDERBEAT development, tells us about the nature of the A: That’s right. When developing medical equipment, it is only
minimally invasive therapy provided by Olympus. by working closely with doctors that we can deliver high quality
and minimally invasive surgery to their patients. Unless the
Even Shorter Hospital Stays end result is more effective in a medical sense, such as being
less invasive, there is no point in simply seeking to improve
Q: To begin with, what is meant by minimally invasive therapy? device performance and developing products that are designed
A: While definitions vary, the term is generally used for specifically for cutting or holding and nothing else. There are
procedures that are less invasive than conventional surgical aspects that only a doctor can judge, therefore, it is essential
techniques. The simplest definition is that the extent of scarring that we work in collaboration with doctors to verify product
to the body is smaller. Also that this results in the patient being benefits.
more quickly rehabilitated back to society. Yet another definition
is to complete a procedure more quickly to reduce the stress Strength of Doctors’ Concern for Patients
on the patient. Also, to be able to receive hospital treatment at
lower medical cost. I think all of these things together make a Q: Does minimally invasive therapy have advantages for
minimally invasive therapy. doctors?
Q: Endoscopic surgery is a typical example of a minimally A: While it may be less invasive for the patient, essentially
invasive therapy. In what ways is it less invasive than endoscopic surgery makes life more difficult for doctors. For
conventional surgical techniques? example, the way doctors must keep in mind risks such as
A: Conventional techniques often involved subjecting the patient hemorrhaging while viewing a video monitor with a limited field
to highly invasive procedures such as making a large incision in of view means the work is more stressful than open procedures
the abdomen, or the severing of rib bones in the case of chest like laparotomy. Choosing a minimally invasive therapy
operations. For various conditions, the widespread adoption should not lead to any drop in the effectiveness or quality of
of endoscopic surgery has seen these replaced by minimally surgery. Numerous measures have to be taken to find ways of

The Olympus Medical Business 39

 came to realize that this would not deliver the level of surgical
quality that doctors were seeking. An important factor in the
creation of superior products, I believe, is that we pursue what
is needed to genuinely satisfy doctors’ needs. While one point
of emphasis in our development is to provide doctors with ideal
treatments they can use without stress, we also need to meet
the doctors’ objective of making these treatments less invasive
for the patient. In other words, to provide treatments that are
more effective in medical terms. In my view, we will be able to
become a market leader when we become capable of offering
maintaining the effectiveness of treatment at the same level as such value.
conventional methods. For example, operations for stomach Q: How do you deal with after-sales service, training, and other
or colon cancer resection require lymph node dissection, a support for doctors?
measure to prevent recurrence. We need to ensure that a doctor A: To ensure that therapeutic devices are used safely, we
can perform this procedure through endoscopic procedures need to provide users with precautions and instructions for
with the same accuracy as in an open laparotomy that gives a use. Particularly in the case of entirely new products like
direct view and allows doctors to feel with their hands. Our job THUNDERBEAT, this activity is even more important than in
is to assist in making this a reality. the past. Including for THUNDERBEAT, we are establishing
Q: Given the pressured and stressful environment you have mechanisms with which we work with marketing department
described, what is it that motivates doctors to give these to prepare materials that describe usage and precautions,
techniques a try? and then our sales force in each market use them as the sales
A: I believe it comes down to concern for their patients’ quality training tool. We hold regular meetings with marketing sections
of life. They are motivated by a genuine desire to find ways to exchange information, and provide follow-up on technical
of providing treatments that place less stress on the patient. A information when required.
common comment from the doctors that we receive during
product development is that even a 1% reduction in the rate of THUNDERBEAT Combines a Hemostasis
cancer recurrence is worth pursuing, and this point cannot be Function with Unprecedented Cutting
compromised, even in the case of minimally invasive surgery. Speed
For ourselves, we appreciate that we need to develop devices
that satisfy this requirement. Q: Can you describe the new products you developed in more
detail? The THUNDERBEAT is a unique surgical energy device
Meeting Doctors’ Need to Act for Patients’ that our competitors don’t have. What makes THUNDERBEAT
Benefit special?
A: The most distinctive feature is the operating mode that
Q: What do you believe is the best way to respond to this simultaneously generates both ultrasonic energy for coagulation
enthusiasm among doctors? and cutting and bipolar high-frequency energy for hemostasis
A: Unlike gastrointestinal endoscopes, Olympus got into the and sealing of blood vessels. Whereas separate specialized
surgical business, particularly therapeutic devices, at a later instruments were needed for these procedures in the past, we
period. We started as a market follower and have developed our have now combined the functions into a single device. As a
products by adding minor enhancements to differentiate them result, THUNDERBEAT offers an unprecedented cutting speed
from what was already available on the market. However, we and reliable hemostasis function. By enhancing the performance

40 The Olympus Medical Business

of basic procedures such as grasping or dissecting tissue, we laparotomy, I believe they can help make the procedure less
have been able to develop a single instrument that can be invasive by shortening operating time.
used for a wide range of purposes. We anticipate that this Naturally, we are also looking to develop new devices that will
will significantly reduce the number of times instruments are allow endoscopic surgery to be used for cases that, currently,
switched during surgery, consequently shortening operating time can only be operated on by laparotomy. For example, as
and relieving stress on the doctor. endoscopic surgery is still only used for about 30% of stomach
Q: In realizing this product concept, what difficulty did you face cancer operations, we are developing devices that will allow
during development? half of the remaining 70% to be done endoscopically, and
A: The hemostasis function is strongly influenced by the device also devices that will allow the other half that continue to be
specifications. We put a lot of design effort into the question of performed by laparotomy to be done with minimally invasive
how to satisfy the conflicting requirements of effectively sealing techniques. Another line of device development is aimed at
blood vessels while at the same time achieving fast cutting. It is making procedures already performed under endoscopy even
not something that can be achieved simply by combining the less invasive. As these examples demonstrate, we continue to
two forms of energy, We spent a long time to study various tip work on a wide range of technical developments.
shapes and energy output conditions before we successfully
realized the product concept.
Q: How does the performance of THUNDERBEAT contribute to
providing minimally invasive therapy?
A: I expect that reliable hemostasis helps prevent complications
such as bleeding during or after the operation. Also, by
realizing improved surgical efficiency, such as procedures being
performed more quickly and less switching of instruments,
operating time gets shorter and the stress on the patient as well
as on the doctor is reduced. Once doctors become accustomed
to the faster surgery made possible by THUNDERBEAT, they
would not be satisfied with surgery performed with conventional
instruments.

Numerous Developments Targeted by

Minimally Invasive Therapy
Q: Please tell us about the future direction of device
development for advancing the field of minimally invasive
therapy?
A: Just as we have applied technologies developed for the
endotherapy devices used with gastrointestinal endoscopes
to endoscopic surgery devices, for example, we believe we
can also apply technologies from endoscopic surgery in open
laparotomy. Since endoscopic surgery is complex and difficult,
progress is being made on technologies to make devices
easier and faster to use. If these devices can also be used in

The Olympus Medical Business 41

Surgical Products

The History of Endoscopic Surgery

Comparison of gallbladder removal surgeries

Endoscopic surgery Laparotomy Endoscopic surgery

Development of Endoscopy Brings a The Accomplishments of

Surgical Techniques "Revolution" Mouret
Surgery is only one means of treating What brought about a recent “revolution” In 1985, the German surgeon Erich Muhe
an injury or curing a disease. In ancient in s ur g e r y w a s t h e d e v e l o p m e n t performed an endoscopic gallbladder
times, the primary treatment for medical of “endoscopic surger y,” a kind of removal.
problems was “internal medicine,”where surgical treatment that makes use of an However, the man who was instrumental
people were treated with drugs without endoscope for access. in the spread of endoscopic surgery on
having surgery. Using a scalpel only As opposed to existing laparotomy and the gallbladder was the French surgeon
brought danger and pain. However, thoracotomy procedures, endoscopic Philippe Mouret. In 1987, he performed
since the 19th century, anesthesia, blood surgery is a new kind of surgery that a gallbladder removal by attaching a
transfusions, and disinfection practices requires only a few small holes to be CCD camera to the laparoscope and
have been developed, and technology made in the skin of the abdomen or projecting the resulting video image on
such as antibiotics has evolved to protect chest. It is performed using long-shafted a TV monitor. He established the current
the condition of the patient during and forceps, electric scalpels and other hand style of laparoscopic surgery where the
after surgery. Surgery has since become instruments while viewing the inside surgery is performed cooperatively under
a main discipline on par with internal of the body through a laparoscope the shared vision of doctors, assistants,
medicine. or a thoracoscope (endoscopes for and engineers.
Never t hele ss, sur ger y is s till viewing the abdomen and chest). The The first endoscopic gallbladder removal
encumbered by the problem of it s reason why endoscopic surgery is so in Japan was performed in 1990 by
tremendous “assault” on the human revolutionary is because it greatly lowers Professor Tatsuro Yamakawa of Teikyo
body. The medical term is for this is the invasiveness of surgical treatment, University. Starting in 1991, endoscopes
“invasiveness.” With most surgeries while at the same time greatly increases were being used to resect the stomach
the patient not only has to recover the patient’s quality of life (QOL). for the treatment of stomach cancer.
from the intended procedure (such as The history of endoscopic surgery goes Since the early 1990’s there have been
removal of the gallbladder) but also back to 1910, when thoracoscopes were many technological advancements in
from the accompanying procedure used in the treatment of pulmonary addition to the accelerated clinical use of
(such as making a large incision in the tuberculosis. In the 1960’s endoscopes endoscopic surgery. As stated previously,
abdomen in order to gain access to the were being used in the fields of urology a key development was the coupling of
gallbladder). Often the incisions required and gynecology in Europe. They became endoscopes to external CCD cameras.
to obtain access to the organ to be a common way to treat urinary tract The ability to view the operation on a
operated are the main reasons for the stones. video monitor allowed for a high level of
patient’s lengthy recovery. In 1978, the German surgeon Kurt Semm cooperation between doctors and their
developed an automatic insuf flator assistants. The development of devices
(a device that pumps carbon dioxide and equipment for surgery in body
gas into the abdominal cavity in order cavities that cannot be reached directly
to expand it and create a space for by hand progressed rapidly.
observation and surgery). This device
greatly facilitated his performance of
endoscopic gynecological surgery.

42 The Olympus Medical Business

 Post-operative scars are small Olympus Medical Training Center Olympus Gyrus-ACMI
(Hamburg, Germany) (Massachusetts, U.S.A.)

Shortened Hospitalization Health Insurance Coverage Olympus and Surgery

Starts in 1992
Endoscopic surgery has many advantages Olympus had already by the end of the
over open surgery. First, for the patient, In Japan, starting in 1992 with gallbladder 1960’s anticipated the use of endoscopes
post-operative scarring is typically much removal, endoscopic surgery is rapidly in surgery. In 1979 we increased our
less compared to laparotomy. Smaller becoming covered by health insurance. capabilities in this field by acquiring the
incisions usually lead to less time spent in Herniopla s t y, lung re s e c tion, and German rigid endoscope manufacturer
the hospital and a faster return to work. gynecological surgeries were covered Winter & Ibe. Since then, Olympus
Shortened hospitalization periods reduce by health insurance starting in 1994, has introduced innovative products,
the financial burden on private payers, stomach resection in 1995, and 18 including surgical endoscopes with
insurance companies and government- surgeries including splenectomy and liver high-definition imaging and the world's-
supported healthcare systems. removal in 1996. first surgical energy device that can
Obviously, for a doctor to perform a Broken down by area of the body, 16 simultaneously generate both high-
revolutionary new procedure he must of these surgeries are for the digestive frequency electric current and ultrasonic
learn a brand new set of skills. However, system, 2 are for the respiratory system, vibrations.
there are benefits to him as well, such 6 are gynecological, and 4 are for the
as being able to magnify the target urinary system.
area and the ability to access organs Activities aimed at spreading endoscopic
that are deep in the body and that are surgery are also popular in Japan. The
therefore difficult to access via open Society for Endoscopic Surgery was
surgery (e.g., kidneys). Compared with started in 1990, and the Japan Society
prior surgical methods where it was for Endoscopic Surger y ( JSES) was
difficult for all to see what the surgeon's established in 1995. The goals of these
hands were actually doing, endoscopy societies include both research and
makes it easier to train young doctors education. As of July 2008, membership
by using the video monitor to show was around 10,000. These societies
the surgical process. The numerous foster increased awareness of endoscopic
benefits of endoscopic surgery, which surgery through various conferences
outweigh its disadvantages, are driving and publications, and certify technical
its popularization. competence in these new procedures
through their physician certification
programs.

The Olympus Medical Business 43

Surgical Products

Endoscopic Surgery Systems and Devices

A Broad Product Line is Key
Equipment used in endoscopic surgery can be roughly divided into
3 groups: 1. Endoscopes, 2. Video processors and light sources, 3.
Instruments like electrosurgical knives. As open surgery is gradually
being replaced by endoscopic surger y, the sophistication of
endosurgical equipment has increased.

Endoscope
There was a time when all surgical endoscopes were metal tubes
containing multiple lenses. However, these are being replaced by
videoscopes that employ CCD image sensors in their tips, due to
the increased sharpness of their image and their improved ease of
maintenance.
In general, videoscopes have a diameter of 5mm and a length of 320-
370mm. Their tips contain a lens, a CCD image sensor, and light guide
fiber bundles for bringing illumination into the body. Some models
are straight, others have deflectable tips. The CCDs in Olympus
endoscopes support high definition imaging. Focusing is unnecessary
due to their broad depth of field. Surgical scope

Rigid endoscope
Urology/Resectoscope
In the ear, nose and throat (ENT) field, slim rigid endoscopes are used
for the observation of ear drums, nasal cavities, vocal chords and
other structures. They are also used in urology for procedures such as
transurethral prostatectomies and renalectomies, and in obstetrics and
gynecology procedures for the removal of uterine myomas.

Scope attached to camera head ENT/Ear drum probes

Video processor, light source

A videoscope requires a video processor and a light source. The
video processor converts the electrical signal coming from the
videoscope into a standard video picture signal for display on an
LCD monitor. Olympus products support optical-digital image
enhancing technologies such as NBI. They are unique in that the
Video processor
models sold in Europe and the U.S. are compatible with both surgical
and gastrointestinal endoscopes. The light source sends light to the
endoscope tip through the light guide cable. A xenon lamp in the light
source provides the light needed to see inside the body.

Insufflator Light source

A necessary part of endoscopic surgery is requirement for an

insufflator. The insufflator feeds carbon dioxide gas into the abdominal
cavity in order to expand it and create a working space to perform
surgery. A special insufflation needle (Veress needle) delivers the
carbon dioxide gas to the peritoneal cavity. The insufflator monitors
the pressure of the peritoneal cavity and automatically pumps in
additional gas as needed to make up for gas that naturally leaks out Insufflator
during surgery.

44 The Olympus Medical Business

Trocar
Trocars are used to create an opening (portal) for passing endoscopic
instrumentation into the body. The endoscope, forceps, electrosurgical
knives, hemostatic/suturing equipment, etc., are then inserted through
the trocar as needed for surgery. Olympus offers various types of
trocars available in diameters ranging from 5-15mm. Currently, the 5mm 11mm 12mm 15mm
most common trocars come with a sheath and are disposable. Trocars

Forceps Forceps

There are various kinds of forceps – such as grasping forceps that hold
tissue and needles, dissecting forceps that mechanically separates
tissue, scissor forceps for cutting tissue, etc.

Hemostasis Clip, Surgical Stapler

Tip of grasping forceps Tip of dissecting forceps
In endoscopic surgery, clips are often used to quickly close a blood
vessel and stop bleeding that cannot be controlled by other means.
The clips are held in a pistol-shaped clip applier. Clips are applied
repeatedly like a stapler.
A surgical stapler is a device that can create two rows of staples
(3-6 cm in length) and then cut the tissue between these rows, all in
one motion. In the tip of the instrument is a cartridge containing the
staples and an automatic knife blade. When the handle is squeezed,
the staples are fired and the tissue is cut and separated, all at the same
time. Hemostatic clip (image) Endoscopic stapler (image)

Ultrasonic Energy Device

Ultrasonic devices for coagulation and cutting by converting electricity
into ultrasonic vibrations. The heat is generated when the tip of the
device (scissors) contacts the tissue and then cuts the tissue and causes
coagulation (hemostasis).

Ultrasonic Coagulation and Cutting System

High-Frequency Electrosurgical Device (Electrode)
Olympus has commercialized electrosurgical knives that use high-
frequency current as an energy source. These devices come in two
types, monopolar with one electrode and bipolar with two electrodes.
Bipolar knifes in particular are capable of ablation for small lesions,
for example. This minimizes the risk of thermal damage to surrounding
tissue.
Electrosurgical Generator

THUNDERBEAT
The world's first integration of Ultrasonic and Advanced Bipolar energies
delivered through a single multi-functional instrument.
THUNDERBEAT
Bipolar high-frequency current features excellent hemostasis and blood vessel
sealing performance, while ultrasonic energy offers superior tissue cutting and
dissection functions. Now, Olympus has successfully developed composite
electrosurgical devices that can output both forms of energy simultaneously.
With their unprecedented cutting speed and high level of hemostasis function, Output Unit
these devices help improve the efficiency of minimally invasive surgery that
places less stress on the patient.

The Olympus Medical Business 45

Surgical Products

Examples of Endoscopic Surgery

Ever since Dr. Mouret of France performed a gallbladder removal
endoscopically in 1987, endoscopic surgery has spread to a number
of fields. Research and application of endoscopic surgery is currently
progressing in t the digestive tract, the respiratory system, the urinary
system, the field of gynecology, etc. This chapter will introduce some
representative examples of this kind of surgery.

Laparoscopic Cholecystectomy
This is the most common type of endoscopic surgery in Japan, with
approximately 26,000 cases being performed each year. It is typically
performed for benign gallbladder problems, such as gallstones, polyps
in the gallbladder, adenomyomatosis of the gallbladder, etc.
The gallbladder is attached to the underside of the liver, and must be
carefully removed using an electrosurgical knife and dissecting forceps.
Next, the cystic artery and cystic duct are clamped with clips and cut
to separate them from the liver. Finally, a trocar is inserted and the Detachment of gallbladder Removal through
gall bladder removed from the body through the trocar using grasping incision
forceps.

Laparoscopy- Assisted Distal Gastrectomy (LADG)

This surgery is limited in application to early-stage cancers from
the lower part of the stomach (pyloric antrum) to the middle of the
stomach (body of the stomach). The standard procedure is to remove
at least two thirds of the stomach and the lymph nodes around the
stomach. The reason this is called a “laparoscopy-assisted” procedure
is that the surgery requires a laparotomy, albeit with a smaller incision.
The two basic methods for reconstructing the stomach are the Billroth
I method and the Roux-en-Y method. In the Billroth I method, the
remaining stomach and the duodenum are joined. In the Roux-en-Y
method, the remaining stomach and the jejunum are joined, and the
Billroth I method Roux-en-Y method
remaining duodenum is connected to the bottom of the jejunum. Food
flows from the stomach to the jejunum, where it mixes with digestive
fluids that flow in from the duodenum.
If these surgeries are not appropriate for the patient, there is still
another kind of stomach cancer surgery called Laparoscopy-Assisted
Total Gastrectomy (LATG).

Laparoscopy-Assisted Colectomy
Colorectal cancer surgeries target the large intestine, cecum, and
rectum. As with stomach cancer, the goal of these surgeries is to
remove the affected area as well as the associated lymph nodes.
Compared to the stomach, the structure of arteries and veins supplying
the colon is simple and the removal of associated lymph nodes is easy.
Therefore, it is said that there is a high chance that laparoscopy-assisted
colectomy may become the standard surgery for colorectal cancer in
the near future.

Nissen fundoplication
Nissen fundoplication is a surgery for treating Gastroesophageal Reflux
Disease (GERD). GERD is a disease characterized by heartburn, chest
pain, bitter taste in the mouth, etc., caused by the reverse flow (reflux)
of stomach fluids back up the esophagus. A laparoscope is used to
surgically create a fold around the esophageal sphincter to prevent the
reverse flow of stomach contents.

46 The Olympus Medical Business

Pulmonary Resection
Lung cancers are now being surgically resected using endoscopes.
Thoracoscopic partial lung resection surgery can be performed for
removing tumors smaller than 3cm in diameter, and lung lobectomies
performed for treating areas greater than 4cm in breadth.

Example of prostate ablation

Prostate Resection or Ablation
Prostate resection is a minimally invasive therapy for the male affliction
of prostatic hyperplasia. This procedure inserts a scope into the urethra
and removes the enlarged prostate by scraping with a bipolar electrode
or other instrument, or shrinks it by ablation.

Others
A resectoscope is inserted Ablation of enlarged prostate
Other types of endoscopic surgery include: for ear, nose, and throat transurethrally in the vicinity of
disorders, there is paranasal sinus surgery; for the urinary system, the neck of the urinary bladder
there is kidney removal surgery; for gynecology, there is surgery for
endometriosis, as well as myomectomies, hysterectomies, etc. All of
these can be performed endoscopically.

Less Invasive Methods

POEM (Per-Oral Endoscopic Myotomy)
The development of less invasive surgical methods is progressing rapidly. One
example is per-oral endoscopic myotomy (POEM), which is becoming recognized
as a treatment for esophageal achalasia. Previous treatments were to take a calcium
antagonist orally, balloon dilatation, or laparoscopic surgery in which part of the
muscle layer from the esophagus to the stomach was removed. POEM is a new
minimally invasive therapy that uses an endoscope to cut the muscle layer of the
esophagus to improve the difficulty swallowing in the esophagus, and therefore does
not leave any scar on the exterior of the body.

Note: Esophageal achalasia is a condition that results in problems such as obstruction in the passage POEM
of food or the stretching of the esophagus due to its peristaltic action (the action by which food is
moved along the esophagus) being obstructed such that the sphincter at the bottom of the esophagus
(esophageal muscle at entry to stomach) does not fully open.

Note: POEM is not yet covered by health insurance in all countries, but is approved as high advanced
medical treatment in Japan.

New Initiatives
OR Integration
This means integrated surgical systems that have the effect of reducing stress on
medical personnel and help endoscopic surgery proceed more smoothly through
the use of centralized control to combine the operation of a number of instruments.
With healthcare reform taking place around the world and a greater focus being
placed on enhancing the efficiency of hospital management, OR integration provides
a functional and efficient surgical environment.

GI in OR
This seeks to ensure that surgery is performed safely and efficiently by, for example,
the use of a gastrointestinal endoscope during endoscopic surgery such as resection
of the stomach or colon to visually check the surgical anastomosis, or to make
follow-up observations after surgery. The endoscopic systems that Olympus supplies
in Europe and America have a major advantage over competing products because
they are designed to also allow the connection of surgical endoscopes.

The Olympus Medical Business 47