Natural orifice translumenal endoscopic surgery: Progress in humans since white paper

Figure 1 The Transanal Endoscopic Operations device from Karl-Storz allows the insertion of rigid or flexible instruments through the anus and is currently used for performing transanal endoscopic microsurgery excisions of rectal tumors. It also has the potential to serve as a stable transrectal natural orifice translumenal endoscopic surgery (NOTES^®) platform. Image used with permission (©Karl Storz).

Figure 2 The TransPort™ multi-channel access device from USGI has been used as a transgastric natural orifice translumenal endoscopic surgery platform. It has a steering mechanism similar to a flexible endoscope, along with multiple, large-diameter channels to accommodate a small-diameter flexible endoscope and other large caliber flexible endoscopic instruments (g-Prox^® tissue anchor device is shown). Image used with permission (©USGI Medical).

Figure 3 The Anubis^® platform from Karl-Storz is an advanced flexible natural orifice translumenal endoscopic surgery platform (in development), with a tip that opens to expose working instruments capable of multiple degrees of freedom controlled by the surgeon. Image used with permission (©Karl Storz).

Figure 4 EndoSamurai is a prototype, advanced platform in development by Olympus. To operate the system, a surgeon uses an intuitive, bi-manual interface to control instruments with multiple degrees of freedom (inset shows close-up of endoscope tip with working instruments). Image used with permission (©Olympus Medical Systems Corp.).

Figure 5 Direct-Drive Endoscopic System from Boston Scientific is a prototype, advanced multi-channel platform currently in development, featuring instruments with multiple degrees of freedom controlled through a bi-manual user interface. Inset figure shows close-up of device tip with a small diameter flexible endoscope in place. Image used with permission (©Boston Scientific).