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

`

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