Medical innovation from endoscopic surgery

endoscopic A number of technological innovations are being promoted in the medical field, and the field of endoscopic surgery is also one of them. In order to reduce the burden of surgery on patients, the application of related technologies is becoming more and more active. Let’s look at medical innovation from the field of endoscopic surgery.

Now, the proportion of endoscopic surgery that replaces open surgery and uses surgical endoscopes (hard endoscopes) that will bring a huge burden to patients is increasing rapidly. Under the major medical trend of low-invasive, this trend will become more and more obvious in the future.

This trend is supported by technological innovation, in which the key technology is “image technology”. Because endoscopic surgery should be performed while looking at the image of the camera inserted into the body (affected part), it can not be implemented without image technology.

When using two-dimensional and low-resolution images, it is difficult to grasp the depth. Therefore, three-dimensional (3D) display and 4K (4000) display are required × 2000 pixel level) and other high-precision display technology to achieve a strong realistic visual effect. A medical device Kwai pointed out that “in the endoscopic surgery, if using 3D images, it is easier to grasp the location relationship when sewing, so it can speed up the operation and reduce the burden of patients”.

There are two main trends in the application of imaging technology in the field of surgical endoscopy, one is the 3D and high refinement of the endoscope itself, and the other is the development of peripheral equipment for processing the images obtained by the endoscope that has realized 3D and high refinement. Here are two examples.

Continuously promote 3D

In terms of 3D and high refinement of the endoscope itself, first of all, the development of 3D (3D endoscope) has been very active in recent years. Although there are few practical cases of the 3D endoscope at present, many enterprises have exhibited the trial products in the world’s largest medical device Exhibition “Medica” and other exhibitions. It is estimated that this market will expand steadily in the future.

Sony predicts that “by 2015, 20% of surgical endoscopes will support 3D”. Sony and Olympus decided to establish a joint venture “Sony Olympus medical solutions” in September 2012, and Sony publicly stated that there is only 3D endoscope to be developed, designed, sold, and manufactured through the joint venture. Sony predicts that the market of this new generation endoscope “will reach 330 billion yen by 2020”, and its goal is to obtain more than 20% market share.

Ultra HD technology

Sony Olympus medical solutions announced that it will develop not only 3D endoscopes but also 4K endoscopes. Such high refinement will continue to develop in the future.

A representative example is 8K (8000) × 4000-pixel level) image signal, i.e. “Ultra HD” endoscope test products have been available. The medical imaging Consortium (MIC) of Japan held a press conference in Tokyo on January 24, 2014, announcing the development of an 8K endoscope and the successful implementation of animal experiments. “This achievement is the first in the world,” said Chiba Minxiong, chairman of MIC and deputy director of the social and clinical research center of Japan’s national adult medical research center and Minister of medical device development.

The animal experiment was carried out on December 7, 2013. The animals used were pigs with viscera very close to human viscera. The 8K endoscopic surgery results obtained in the experiment mainly include three aspects: (1) being able to use the endoscope for microsurgery, (2) turning the display into a television microscope, and (3) making use of the space in the abdominal cavity.

Ease the doctor’s tension

In microsurgery, the 0.02 ~ 0.029mm thick silk thread commonly used in microsurgery can also be seen with the naked eye. In addition, we can also see the cross-section of liver microvessels that could not be seen by the previous HD endoscope.

In terms of TV microscope, even if some images taken by 8K endoscope are enlarged, clear images can be obtained. Therefore, doctors do not need to wear “surgical magnifying glasses” and other equipment during surgery.

In terms of space in the abdominal cavity, clear images can be obtained even if the endoscope is not close to the affected area. Therefore, it can ensure space and eliminate “doctors’ tension about the endoscope touching surgical instruments”.

President Chiba said that the 8K endoscope “can obtain the natural depth that only high-precision images can have”. However, this vertical feeling is different from the three-dimensional feeling of 3D images. Therefore, “even if 8K endoscope comes out, it will not be superior to the 3D endoscope, but coexist with it. Of course, it would be great to realize an endoscope that supports both 8K and 3D”.

On the other hand, President Chiba explained the difference between 4K and 8K as follows: “the main difference between 4K and 8K and the current HD endoscope is whether it can exceed the limit of human vision. The difference between 4K and 8K is mainly sensory. Once you see 8K, you can’t go back to 4K.”

Technology using night vision camera

In addition, some enterprises are trying to improve the “sensitivity” of the endoscope by using an independent technology, and the pioneer who has announced to set foot in the development of cameras for an endoscope is a good example. The company reached business cooperation with Otsuka medical equipment company, a medical device manufacturer of Otsuka pharmaceutical, at the end of October 2012. The two sides will jointly develop an endoscope with a pioneering camera and promote it to the market through Otsuka medical equipment company.

Pioneer plans to adopt “heed-harp” technology in the development of endoscope cameras, so as to achieve significant differentiation from the traditional products of other companies. Heed-harp combines the cold cathode type planar electron source “heed” (high-efficiency electron emission device) developed by pioneer and the ultra-high sensitivity photoelectric conversion film “harp” (high gain avalanche amorphous photoconductor) developed by NHK Transmission Technology Research Institute.

When light enters from one side of the harp film, holes corresponding to the amount of light will be generated in the harp film with amorphous selenium (a-Se) as the main component. Holes increase like avalanches in the harp membrane. These holes are neutralized by the electrons released by heed, and an image can be formed by detecting the current at this time. This technology has been disclosed in the “NHK Technology Research Exhibition” and other occasions before and has attracted great attention from relevant people in the industry.

The biggest feature of the camera using this technology (heed-harp camera) is high sensitivity. For example, in an environment with an ambient illuminance of 0.6lx (equivalent to moonlight), a clear image can also be obtained without digital compensation processing.

In order to make full use of this feature of heed-harp technology, Pioneer has also explored many applications such as night vision cameras in the past and trial-produced corresponding cameras. But so far, the technology has not been put into practice for any purpose.

As a new application field, the pioneer aims at the endoscope, hoping to make the endoscope have new characteristics by using this technology to observe the dark body. Pioneer proposed this idea to Otsuka medical equipment company, which was very interested in the strength of the heed-harp camera and decided to jointly develop the endoscope.

The market responded well

In terms of peripheral development for 3D and high-precision processing of endoscope images, it is expected that a new generation of 3D and high-precision endoscopes will be popularized in the future, so the development of peripherals has become active recently.

For example, Sony launched a 3D head-mounted display (3D HMD) used with 3D surgical endoscopy in August 2013. The surgeon wears it on his head, and the image of the endoscope can be directly displayed in front of his eyes (Figure).

This 3D HMD is composed of a “head-mounted image processor unit” responsible for the input, output, and control of endoscope image signals and a “head-mounted display” worn on the head. The price is open, and the market price is expected to be about 1.5 million yen (about 92000 yuan). First, it will be listed in Japan, with an annual sales target of 1000 units.

The market reaction to this product is very good. Sony staff said, “I didn’t expect that so many medical institutions will come to consult after the product release. We are too busy”, “many medical institutions say this product has Sony characteristics”.

Adopt a different design from home 3D HMD

When developing this 3D HMD, Sony adopted a special design for medical institutions and improved it according to the listed household 3D HMD. Specifically, it improves wearability and can also be used for long-term surgery; A small window for adjustment is set. If it is crooked, it can also be adjusted with the help of others; The structure near the hand can be seen, which is convenient for taking and placing surgical instruments.

These designs were jointly studied and implemented with Tokyo Medical and Dental University in Japan. Sony launched the project of accelerating joint research and talent training in the medical field with Tokyo Medical and Dental University in April 2012. The project has been studying how to improve the home 3D HMD so that it can be used in endoscopic surgery.

In addition, the display part of medical 3D HMD is the same as that of household 3D HMD, which adopts an organic EL panel. Sony said that “the image response is excellent and can keep up with the speed of surgery to display the image”.

Glasses or naked eyes?

Although 3D HMD can be regarded as an advanced means to confirm the images of 3D surgical endoscopy, the method of using the 3D display to confirm the images is widely used in medical sites. Sony, Panasonic, and other enterprises also participated in the market competition for 3D LCD.

Panasonic health medical devices and Sony launched 26 inch and 32 inch 3D liquid crystal displays displaying 3D surgical endoscopic images in April and August 2013 respectively (Panasonic health medical devices has launched 32-inch products in 2011), with 1920 pixels × 1080。 Panasonic health medical device company said that “in order to pursue realism, it adopts image processing technology different from ordinary TV sets, with different emphasis on image processing”.

In terms of 3D display, each display adopts the way of pasting polarizing filter on the liquid crystal panel and viewing with circular polarizing glasses. There is also an active shutter mode for viewing 3D images with glasses. However, Panasonic health medical device company pointed out that “installing a battery on glasses will become very heavy, and it will be very hard to wear it during several hours of surgery, so doctors don’t like it”. So many people think that “circular polarization mode is the current standard model”.

Look forward to furthering technological innovation

If you don’t use 3D HMD to present images directly in front of your eyes, but use the display, what doctors really want is the naked eye method, not the glasses method. Panasonic health medical devices also said that “we have not considered the naked eye method”.

Now the naked eye method can not be realized immediately because there is no 3D display technology that can meet the needs. In the field of surgery such as endoscopy, doctors look at the display while doing surgery. Therefore, a 3D display should be ensured even if the viewing angle changes. There is no naked-eye 3D display technology that can meet this requirement. In the future, this naked-eye 3D display technology needs to be developed for the medical field.

Using robotics

In addition, Tokyo Medical and Dental University and Tokyo University of technology are developing an “endoscope support” that can be linked with the head movement of the surgeon to operate the 3D endoscope. In endoscopic surgery, doctors (assistants) other than the knife doctor usually hold the camera and change the position of the camera according to the instructions of the knife doctor. If this endoscope support is used, the knife doctor can intuitively control the camera without an assistant holding the camera.

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