TY - JOUR

T1 - The "iceberg Phenomenon"

T2 - As soon as one technological problem in NOTES is solved, the Next one appears!

AU - Feussner, Hubertus

AU - Fiolka, Adam

AU - Schneider, Armin

AU - Cuntz, Timo

AU - Coy, Johannes

AU - Von Tiesenhausen, Cyrill

AU - Höller, Kurt

AU - Weede, Oliver

AU - Konietschke, Rainer

AU - Borchard, Jan Hinnerk

AU - Ellrichmann, Mark

AU - Reiser, Silvano

AU - Ortmaier, Tobias

N1 - Funding information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported in part by the Deutsche Forschungsgemeinschaft (DFG) (FOR 1321).

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Purpose. Though already proclaimed about 7 years ago, natural orifice transluminal endoscopic surgery (NOTES) is still in its early stages. A multidisciplinary working team tried to analyze the technical obstacles and identify potential solutions. Methods. After a comprehensive review of the literature, a group of 3 surgeons, 1 gastroenterologist, 10 engineers, and 1 representative of biomedical industry defined the most important deficiencies within the system and then compiled as well as evaluated innovative technologies that could be used to help overcome these problems. These technologies were classified with regard to the time needed for their implementation and associated hindrances, where priority is based on the level of impact and significance that it would make. Results. Both visualization and actuation require significant improvement. Advanced illumination, mist elimination, image stabilization, view extension, 3-dimensional stereoscopy, and augmented reality are feasible options and could optimize visual information. Advanced mechatronic platforms with miniaturized, powerful actuators, and intuitive human-machine interfaces could optimize dexterity, as long as enabling technologies are used. The latter include depth maps in real time, precise navigation, fast pattern recognition, partial autonomy, and cognition systems. Conclusion. The majority of functional deficiencies that still exist in NOTES platforms could be overcome by a broad range of already existing or emerging enabling technologies. To combine them in an optimal manner, a permanent dialogue between researchers and clinicians is mandatory.

AB - Purpose. Though already proclaimed about 7 years ago, natural orifice transluminal endoscopic surgery (NOTES) is still in its early stages. A multidisciplinary working team tried to analyze the technical obstacles and identify potential solutions. Methods. After a comprehensive review of the literature, a group of 3 surgeons, 1 gastroenterologist, 10 engineers, and 1 representative of biomedical industry defined the most important deficiencies within the system and then compiled as well as evaluated innovative technologies that could be used to help overcome these problems. These technologies were classified with regard to the time needed for their implementation and associated hindrances, where priority is based on the level of impact and significance that it would make. Results. Both visualization and actuation require significant improvement. Advanced illumination, mist elimination, image stabilization, view extension, 3-dimensional stereoscopy, and augmented reality are feasible options and could optimize visual information. Advanced mechatronic platforms with miniaturized, powerful actuators, and intuitive human-machine interfaces could optimize dexterity, as long as enabling technologies are used. The latter include depth maps in real time, precise navigation, fast pattern recognition, partial autonomy, and cognition systems. Conclusion. The majority of functional deficiencies that still exist in NOTES platforms could be overcome by a broad range of already existing or emerging enabling technologies. To combine them in an optimal manner, a permanent dialogue between researchers and clinicians is mandatory.

KW - actuation

KW - autonomy

KW - NOTES

KW - platforms

KW - robotics

KW - visualization

UR - http://www.scopus.com/inward/record.url?scp=84947424934&partnerID=8YFLogxK

U2 - 10.1177/1553350615573578

DO - 10.1177/1553350615573578

M3 - Article

C2 - 25733547

AN - SCOPUS:84947424934

VL - 22

SP - 643

EP - 650

JO - Surgical innovation

JF - Surgical innovation

SN - 1553-3506

IS - 6

ER -