Future Endoscopic Tools and Platforms for Endoluminal Surgery

  • Kiyokazu NakajimaEmail author
  • Jeffrey W. Milsom


Future endoluminal surgery including advanced colonoscopic intervention will become a reality not by developing super-performance flexible endoscopes but by reconsidering the fundamental elements of flexible endoscopy such as insufflation, evacuation, and stabilization of working space. Truly usable ancillary tools will also contribute to overcome each technical difficulty. A continuous research and development effort using recent medtech collaboration is essential, but a change of endoscopists’ and surgeons’ way of thinking, “how future endoscopy should be,” is even more important.


Endoluminal surgery Endoscopic intervention Therapeutic endoscopy Colonoscopy Devices Tools Platforms 

Supplementary material

Video 23.1

Pressure-regulated colonoscopy using GW-200 and related devices (110718 kb)

Video 23.2

ESD using Endotornado overtube in swine esophagus (MOV 152533 kb)


  1. 1.
    Uraoka T, Parra-Blanco A, Yahagi N. Colorectal endoscopic submucosal dissection: is it suitable in western countries? J Gastroenterol Hepatol. 2013;28:406–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Nakajima K, Nishida T, Milsom JW, Takahashi T, Souma Y, Miyazaki Y, Iijima H, Mori M, Doki Y. Current limitations in endoscopic CO2 insufflation for NOTES: flow and pressure study. Gastrointest Endosc. 2010;72:1036–42.CrossRefPubMedGoogle Scholar
  3. 3.
    Nakajima K, Lee SW, Sonoda T, Milsom JW. Intraoperative carbon dioxide colonoscopy:a safe insufflation alternative for locating colonic lesions during laparoscopic surgery. Surg Endosc. 2005;19(3):321–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Yasumasa K, Nakajima K, Endo S, Ito T, Matsuda H, Nishida T. Carbon dioxide insufflation attenuates parietal blood flow obstruction in distended colon: potential advantages of carbon dioxide insufflated colonoscopy. Surg Endosc. 2006;20:587–94.CrossRefPubMedGoogle Scholar
  5. 5.
    Souma Y, Nakajima K, Takahashi T, Nishimura J, Fujiwara Y, Takiguchi S, Miyata H, Yamasaki M, Doki Y, Nishida T. The role of intraoperative carbon dioxide insufflating upper gastrointestinal endoscopy during laparoscopic surgery. Surg Endosc. 2009;23:2279–85.CrossRefPubMedGoogle Scholar
  6. 6.
    Dellon ES, Hawk JS, Grimm IS, Shaheen NJ. The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc. 2009;69:843–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Kozu T, Saito D. A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest Endosc. 2007;65:537–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Nakajima K, Moon JH, Tsutsui S, Miyazaki Y, Yamasaki M, Yamada T, Kato M, Yasuda K, Sumiyama K, Yahagi N, Saida Y, Kondo H, Nishida T, Mori M, Doki Y. Esophageal submucosal dissection under steady pressure automatically controlled endoscopy (SPACE): a randomized preclinical trial. Endoscopy. 2012;44:1139–48.CrossRefPubMedGoogle Scholar
  9. 9.
    Yamada T, Hirota M, Tsutsui S, Kato M, Takahashi T, Yasuda K, Sumiyama K, Tsujii M, Takehara T, Mori M, Doki Y, Nakajima K. Gastric endoscopic submucosal dissection under steady pressure automatically controlled endoscopy (SPACE); a multicenter randomized preclinical trial. Surg Endosc. 2015;29:2748–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Hirota M, Miyazaki Y, Takahashi T, Yamasaki M, Takiguchi S, Mori M, Doki Y, Nakajima K. Steady pressure CO2 colonoscopy: its feasibility and underlying mechanism. Dis Colon Rectum. 2014;57:1120–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Kato M, Nakajima K, Yamada T, Hirota M, Miyazaki Y, Yamasaki M, Nishida T, Mori M, Doki Y, Tujii M, Takehara T. Esophageal submucosal dissection under steady pressure automatically controlled endoscopy (SPACE): a clinical feasibility study. Endoscopy 2014;46:680–684.Google Scholar
  12. 12.
    Mattes D, Silajdzic E, Mayer M, Horn M, Scheidbach D, Wackernagel W, Langmann G, Wedrich A. Surgical smoke management for minimally invasive (micro) endoscopy: an experimental study. Surg Endosc. 2010;24:2492–501.CrossRefPubMedGoogle Scholar
  13. 13.
    Takahashi H, Yamasaki M, Hirota M, Miyazaki Y, Moon JH, Souma Y, Mori M, Doki Y, Nakajima K. Automatic smoke evacuation in laparoscopic surgery: a simplified method for objective evaluation. Surg Endosc. 2013;27:2980–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Takahashi H, Hirota M, Takahashi T, Yamasaki M, Mori M, Doki Y, Nakajima K. Simultaneous automatic insufflation and smoke evacuation system in flexible gastrointestinal endoscopy. Endoscopy. 2016;48:579–83.CrossRefPubMedGoogle Scholar
  15. 15.
    Swanstrom LL. NOTES: platform development for a paradigm shift in flexible endoscopy. Gastroenterology. 2011;140:1150–1154.e1151.Google Scholar
  16. 16.
    Yeung BP, Gourlay T. A technical review of flexible endoscopic multitasking platforms. Int J Surg. 2012;10(7):345–54.CrossRefPubMedGoogle Scholar
  17. 17.
    Hirota M, Kato M, Yamazaki M, Kawai N, Miyazaki Y, Yamada T, Takahashi T, Takehara T, Mori M, Doki Y, Nakajima K. A novel endoscopic submucosal dissection technique with robust and adjustable tissue traction. Endoscopy. 2014;46:499–502.CrossRefPubMedGoogle Scholar
  18. 18.
    Jirapinyo P, Slattery J, Ryan MB, Abu Dayyeh BK, Lautz DB, Thompson CC. Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Endoscopy. 2013;45:532–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Yanagimoto Y, Yamasaki M, Nagase H, Kanemura T, Higashi S, Miyazaki Y, Makino T, Takahashi T, Kurokawa Y, Miyata H, Takiguchi S, Mori M, Doki Y, Nakajima K. Endoscopic anti-reflux valve for post-esophagectomy reflux: an animal study. Endoscopy. 2016;48:1119–24.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Next Generation Endoscopic Intervention (Project ENGINE)Global Center for Medical Engineering and Informatics, Osaka UniversityOsakaJapan
  2. 2.Department of Surgery, Division of Colorectal SurgeryWeill Cornell Medical College—New York Presbyterian HospitalNew YorkUSA

Personalised recommendations