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Ithaca 7.2007
Futuristic TherapiesFuturistic Therapies
Ithaca 7.2007
Technological Advances inIntestinal Surgery
““What is now provedWhat is now proved was once only imagin’d”was once only imagin’d”
William Blake, William Blake, The Marriage of Heaven and Hell (1790)The Marriage of Heaven and Hell (1790)
Ithaca 7.2007
Colon &Rectal Surgery:
Early 1900’s1900’s
•Anastomoses: NOT SAFEAnastomoses: NOT SAFE•Functional preservation: NOT RELEVANTFunctional preservation: NOT RELEVANT•Technical aspects SIMPLER:Technical aspects SIMPLER:
Anastomoses
Functional PreservationTechnical Aspects
-Knife-Scissors-Clamp-Thread & Needle
Ithaca 7.2007
Total Colectomy 2007Total Colectomy 2007 (Laparoscopic) (Laparoscopic)
Main blood vessels: Main blood vessels: sealed by bipolar energysealed by bipolar energy •Clamp
•clips•needle•thread•scissors
NO!NO!
Ithaca 7.2007
Ithaca 7.2007
Key Technologies: Near FutureKey Technologies: Near Future
1.1. Optics/Image ProcessingOptics/Image Processing2.2. Energy devices(e.g. harmonic scalpel, Energy devices(e.g. harmonic scalpel,
Bipolar energy)Bipolar energy)3.3. New Anastomotic devicesNew Anastomotic devices4.4. Endoscopy/laparoscopy combinationsEndoscopy/laparoscopy combinations5.5. OR FutureOR Future
Ithaca 7.2007
New Laparoscopes
•Smaller, better optical properties Smaller, better optical properties (HDTV)(HDTV)•Magnification 15-20X and more!Magnification 15-20X and more!•FlexibleFlexible
Ithaca 7.2007
Future of imaging: HD- Better resolution/color reproductionStandard Definition High Definition
Ithaca 7.2007
CCD-compatible HDTV
Videoprocessor for HDTV signal processing
Image output with HDTV picture signals
Display on HDTV-compatible monitor
EICP-D to record HDTV digital signals in DVD
SI to record HDTV digital signals in server via network
FACTORS
Ithaca 7.2007
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Applications of Narrow Band Imaging
Ithaca 7.2007
Potential of the intra/post-operative NBI colonoscopy
Normal Light SourceNormal Light Source NBINBI
Anastomosis after sigmoidectomyAnastomosis after sigmoidectomy
Ithaca 7.2007
In Vivo Imaging of Ovary: MouseImages: Rebecca M. Williams, Andrea Flesken-Nikitin, Alexander
Nikitin, Watt W. Webb and Warren R. Zipfel, Cornell University, 2005, 9-P41-RR04224-18.
epithelium
breathing artifact
corpus luteum
20 m
Multiphoton imagingMultiphoton imaging
Ithaca 7.2007
Endoscopy in the OR
OR
GI LabLaparoscopy
Open
Endoscopy
“Invasiveness”
Less Invasive
More Therapeutic
FUTURE
Ithaca 7.2007
Combined CO2 Colonoscopy & Laparoscopy
Ithaca 7.2007
2
3
ExposureExposure
Surgical ControlSurgical Control
1 Endoscopic polypectomyEndoscopic polypectomy
Ithaca 7.2007
- Confirm the best position of the ileostomy
Combined procedure: Stoma required
Tip of endoscope
Ithaca 7.2007
OPERATING ROOM of FUTURE
• WOK: Wall of Knowledge (multiple flat WOK: Wall of Knowledge (multiple flat screens)screens)
• Input:Input:– OPTICS, XRAYS, MEDICAL RECORDOPTICS, XRAYS, MEDICAL RECORD– Consultations(Pathology,other specialists)Consultations(Pathology,other specialists)– Teaching input from remote siteTeaching input from remote site
• Bluetooth technologies (phone,data, Bluetooth technologies (phone,data, images)images)
Ithaca 7.2007
OPERATING ROOM of the FUTURE
Wall of Knowledge
“Telestration”
Ithaca 7.2007
Other Future InitiativesOther Future InitiativesTelepresence RoboticsRobotics
Expert surgeon can Expert surgeon can •““enter” the remote ORenter” the remote OR•Perform surgical actionsPerform surgical actions•Assist the team thereAssist the team there
Robots will:Robots will:•Make complex decisionsMake complex decisions•Particularly impt in battlefieldParticularly impt in battlefield or disaster situationsor disaster situations
Ithaca 7.2007
Summary: Colon & Rectal Disease Treatment
• Increase in the incidence of C&R diseases Increase in the incidence of C&R diseases (worldwide), particularly cancer(worldwide), particularly cancer
• Minimally Invasive Surgery: More Minimally Invasive Surgery: More commoncommon
• Cornell must assume a leadership role in Cornell must assume a leadership role in the development of this fieldthe development of this field