Was there surgery?

Avoiding incisions during surgery, quick recovery and pain reduction are just some of the advantages of endoscopic surgery. About endoscopic surgeries and the tiny cameras that make the process possible

Despite the impressive medical developments that can be seen in recent decades, there are still many diseases for which the treatments do not provide a satisfactory response, or the use of the advanced technologies that we know and develop could have given the patient and the doctor considerable benefits. There are many reasons why the existing solutions do not provide a satisfactory response: for example, Existing treatment may involve significant medical risks, or it may cause pain and unwanted side effects; The cost of medical treatment can be high, or the recovery time from the treatment is relatively long.

Aesthetics also sometimes play an important role in the considerations for carrying out a medical procedure, when in a significant part of the medical treatments noticeable scars are caused; And finally, it is possible that an existing treatment will be difficult to perform and requires a unique skill, and a technological improvement can allow the doctor to perform it more easily and expand the circle of doctors who can perform it. Indeed, in recent years, innovative, less invasive (but safe and effective) therapeutic procedures have been proposed, designed to replace existing procedures.

The benefits of endoscopy
The endoscopy devices led, little by little, to the conversion of some of the previous medical procedures to non-invasive procedures. That is, instead of entering the organ through an incision in the body, they began to use an endoscope (a long, flexible tube) which is inserted through a natural opening in the body without making an incision in the skin. For example, the endoscope is inserted through the oral cavity, nose, trachea or anus. The duration of recovery from endoscopic procedures is shorter than in open surgeries and laparoscopic surgeries (minor surgeries).

The endoscope is a flexible tube that has lighting, an imaging option and a system that allows for guidance inside the body cavities. Moreover, endoscopes also contain air and water perfusion systems to clear the field of vision of secretions or dirt, as well as an operation channel, which allows the insertion of instruments to perform additional operations, such as local tissue treatment. For example, taking a biopsy from the tissue of the esophagus or stomach to detect malignant or benign tumors, treating local bleeding, breaking stones in the gallbladder or urinary tract, and more.

The main advantage of treatment with endoscopic methods is the avoidance of incisions in the body during surgery. Without incisions, there is almost no pain after the operation, the trauma to the tissue is minimal and the recovery is faster. In addition to this, the absence of incisions and scars improves the patients' body image and prevents complications arising from the incision itself, such as wound infection or the development of a hernia in the scar. Another advantage is that the therapists and the patients perceive the endoscopic operations as less dangerous than surgery, therefore the degree of anxiety about the endoscopic procedure or its results is less.

The quick recovery shortens the duration of hospitalization and the time until returning to normal activity, and this has considerable economic significance. Another advantage of endoscopic operations is that some of them can be performed under local anesthesia or light anesthesia, although this advantage is limited to relatively simple operations, usually diagnostic.

The advantages explain why the popularity of endoscopic operations as a substitute for surgery has increased, and why this solution replaces surgery for almost every medical problem that has a solution of this type. When there is an endoscopic solution, only patients are operated on in whom it fails, or the patients are not suitable for such operations (for example, because of previous operations that distort the normal anatomy, or other diseases that the patient suffers from may complicate the overall treatment).

Disadvantages of endoscopy
The endoscopic operations also have disadvantages. The main disadvantages are that the field of view through the endoscope is limited and the ability to drive through the natural openings is limited. These shortcomings may cause complications that sometimes outweigh the risks of normal surgery. For example, if the operator is not careful, it is possible to damage internal organs, such as perforation of the intestine, the treatment of which will require surgery.

Other disadvantages arise from the diameter limitation: entry into the body through a natural orifice, for example entry through the mouth into the esophagus and stomach, can be performed with an endoscope whose diameter does not exceed 15 mm, and this is due to the diameter of the esophagus. To break or remove stones in the gallbladder, for example, it is necessary to pass through a tube with a diameter smaller than approximately three millimeters. Hence, the ability to transfer various components through the endoscope - such as tools for breaking the stones or removing them, or a laser fiber for local treatment - is limited. This limitation, along with the desire to perform endoscopic procedures that will replace normal surgeries, are leading the world of medical devices to miniaturization.

Mini video camera
By virtue of its purpose, every endoscope must include a system that allows the doctor to observe internal organs in the patient's body. In the past, this system was based on optical fibers. Later, an electronic video system was developed which gives a better image and has a higher resolution. Today, endoscopes based on optical fibers are still sold, but most of the endoscopes currently sold to hospitals are based on an electronic camera.

Their endoscopes have a flexible tube, it is almost impossible to use a large camera, which is connected to the end of the device that is outside the body of the person being operated on in combination with lenses along the endoscope tube, similar to the solutions suitable for rigid tubes (for periscopes). Therefore, flexible endoscopes use a small camera located at the end of the endoscope in the part inserted into the patient's body.

Even so, there are places in the body where performing the procedure is difficult for their flexible endoscopes with a camera at the end if, for example, access to an organ is difficult or the diameter of the organ is very small, 3-1 millimeters. In order to overcome these difficulties, tools based on optical fibers were used in the past. In other cases, surgeries were (and still are) performed to reach the area that requires treatment, for example in ear, nose and throat surgeries, brain surgeries and heart surgeries. A small enough camera makes it possible to produce tiny endoscopes with a diameter of the order of 2 millimeters, and sometimes even less. Also, using the tiny camera leaves room in the diameter of the endoscope, thus making it possible to perform operations that are currently difficult or impossible to perform: it is possible, for example, to add working channels to the endoscope, thus using two surgical tools at the same time.

Medigus, an Israeli company from Omer, has completed the development of a disposable video camera that is the smallest in the world. The diameter of the camera is 1.2 millimeters (including packaging which is a thin mechanical box that holds the sensor). Among other things, the camera has a sensor, lens system, microelectronics and packaging. The detector in the new camera, based on CMOS technology (acronyms: Complementary Metal Oxide Semiconductor), was developed and produced in cooperation with Tower Semiconductor Ltd. from Migdal Ha'Emek and with the support of the chief scientist.

Tiny sensor, sharp image
In the world of sensors there are two types, one that is used to receive the reflected light from the tissue and convert it into an analog signal, which will be sent via a cable for video processing in an external system known as a video processor; and the second detector that includes all the video processing circuits on the sensor itself.

The first type allows for a significant amount of pixels (photodiodes that convert the reflected light into electrons) compared to the second which allows for simplifying the video system and reducing its cost. Medigos and Tower Semiconductor engineers have developed a sensor with approximately 50,000 pixels that provides a color image, particularly sensitive, which is sent to an external video processor. Since it is a small sensor, the signal transmission is performed through current conversion as opposed to the voltage conversion method common in similar applications. The advantage of this method is a better signal-to-noise ratio and filtering out external noises.

The camera is intended for use in various medical applications which until now could not be performed using video cameras, such as ENT surgery, gall bladder surgery, brain base surgery and more. One of the distinct advantages of such a unique camera, in addition to the quality of the image, is the possibility of combining the camera with disposable medical tools, such as narrow diameter rods for cutting, tightening, breaking, etc.

In light of the growing demand for disposable medical products and the demand for non-invasive procedures, the new camera, which provides high-quality video, is intended for integration in various fields such as gastroenterology, orthopedics, gynecology, otolaryngology and unique endoscopic abdominal surgeries. Using a disposable camera eliminates the need for a sterilization procedure that is necessary in most endoscopic procedures and involves considerable cost, time, skill and, of course, exposure to infections.

If so, the new camera makes it possible to replace the easily broken optical fiber with an equivalent component in size, about a millimeter, but with a higher diagnostic capacity (resolution). It also enables the construction of modern disposable endoscopic medical equipment, narrow in diameter, which is based on the camera as well as what has been considered science fiction until now - penetration into places such as blood vessels, kidneys, gall bladder, brain and more.

In brain base surgery, it was common until now to perform a complex surgery involving the removal of part of the bone tissue. In the future, we expect the development of modern endoscopic tools, based on cameras, in order to perform complex medical procedures in this sensitive organ in minimally invasive surgery through the nose, without the need to remove the bone.

Dr. Elazar Sonnenshein is the CEO of Medigus Ltd.