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Futuristic Therapies. Technological Advances in Intestinal Surgery. “What is now proved was once only imagin’d”. William Blake, The Marriage of Heaven and Hell (1790). Colon &Rectal Surgery: Early 1900’s. Anastomoses. Anastomoses: NOT SAFE Functional preservation: NOT RELEVANT

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Futuristic therapies

Ithaca 7.2007

Futuristic Therapies


Technological advances in intestinal surgery

Ithaca 7.2007

Technological Advances inIntestinal Surgery

“What is now proved

was once only imagin’d”

William Blake, The Marriage of Heaven and Hell (1790)


Ithaca 7.2007

Colon &Rectal

Surgery:

Early 1900’s

Anastomoses

  • Anastomoses: NOT SAFE

  • Functional preservation: NOT RELEVANT

  • Technical aspects SIMPLER:

Functional Preservation

Technical Aspects

-Knife

-Scissors

-Clamp

-Thread & Needle


Total colectomy 2007 laparoscopic

Ithaca 7.2007

Total Colectomy 2007 (Laparoscopic)

Main blood vessels: sealed by bipolar energy

  • Clamp

  • clips

  • needle

  • thread

  • scissors

NO!



Key technologies near future

Ithaca 7.2007

Key Technologies: Near Future

  • Optics/Image Processing

  • Energy devices(e.g. harmonic scalpel, Bipolar energy)

  • New Anastomotic devices

  • Endoscopy/laparoscopy combinations

  • OR Future


New laparoscopes

Ithaca 7.2007

New Laparoscopes

  • Smaller, better optical properties (HDTV)

  • Magnification 15-20X and more!

  • Flexible


Future of imaging hd

Ithaca 7.2007

Future of imaging: HD

  • Better resolution/color reproduction

Standard Definition

High Definition


Ithaca 7.2007

FACTORS

EICP-D to record HDTV digital signals in DVD

Display on HDTV-compatible monitor

Image output with HDTV picture signals

Videoprocessor for HDTV signal processing

CCD-compatible HDTV

SI to record HDTV digital signals in server via network


`

Ithaca 7.2007

Applications of Narrow Band Imaging


Potential of the intra post operative nbi colonoscopy

Ithaca 7.2007

Potential of the intra/post-operative NBI colonoscopy

Anastomosis after sigmoidectomy

NBI

Normal Light Source


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.

20 mm

breathing artifact

epithelium

corpus luteum

Multiphoton imaging

Ithaca 7.2007


Ithaca 7.2007

Endoscopy in the OR

“Invasiveness”

Open

Laparoscopy

GI Lab

Less Invasive

Endoscopy

FUTURE

OR

More Therapeutic


Combined co2 colonoscopy laparoscopy

Ithaca 7.2007

Combined CO2 Colonoscopy & Laparoscopy


Ithaca 7.2007

1

Endoscopic polypectomy

2

Exposure

3

Surgical Control


Combined procedure: Stoma required

Ithaca 7.2007

Tip of endoscope

  • Confirm the best position of the ileostomy


Operating room of future

Ithaca 7.2007

OPERATING ROOM of FUTURE

  • WOK: Wall of Knowledge (multiple flat screens)

  • Input:

    • OPTICS, XRAYS, MEDICAL RECORD

    • Consultations(Pathology,other specialists)

    • Teaching input from remote site

  • Bluetooth technologies (phone,data, images)


Operating room of the future

Ithaca 7.2007

OPERATING ROOM of the FUTURE

Wall of Knowledge

“Telestration”


Other future initiatives

Ithaca 7.2007

Other Future Initiatives

Telepresence

Robotics

  • Robots will:

  • Make complex decisions

  • Particularly impt in battlefield

  • or disaster situations

  • Expert surgeon can

  • “enter” the remote OR

  • Perform surgical actions

  • Assist the team there


Summary colon rectal disease treatment

Ithaca 7.2007

Summary: Colon & Rectal Disease Treatment

  • Increase in the incidence of C&R diseases (worldwide), particularly cancer

  • Minimally Invasive Surgery: More common

  • Cornell must assume a leadership role in the development of this field


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