Some background
I’m going to hypothesis something here. Endolumenal robots will have their own right, own place and own capabilities. But an incredible new style of surgery will be unlocked once the endolumenal robots start to meet up with the laparoscopic robots. Rendezvous.
Back in 2007 I was highly involved in creating a company called MINOS Medical (Minimally invasive natural orifice surgery) - and as I like to believe it was way ahead of it’s time.
We were involved in NOTES (Natural Orifice Translumenal Endoscopy Surgery) - where you went into the mouth - or anus or vagina (or uterus in one of our devices) and then passed out across the wall and entered the abdominal space.
It was often called “No Scar” surgery.
But at the same time we also developed a set of tools for NOS (Natural Orifice Surgery) - which was carrying out pretty complex endolumenal therapeutic procedures. So not crossing the wall of the bowel to oesophagus or stomach - but instead staying inside the lumen and operating with pretty advanced instruments inside the structure.
At the time we did some very adventurous work on removing the appendix from inside the lumen through inversion (Appendoectomy) as we termed it. We also did work on inversion and banding closure of diverticulum in the bowel (Diverlite) - thus avoiding later diverticulosis because we closed off the diverticulum (small bowel hernias along the Tenia).
The issue at the time was that endolumenal robots that operated inside structures were just being imagined - and instead we did all of our work using good old fashioned mechanical systems - with a lot of push n pull - a lot of Nitnol flex shape graspers, long overtubes and host of cool stuff.
We also relied heavily on standard endoscopes which made the manoeuvres quite hard. It was especially challenging in the duodenal structures where we were navigating Spyglass scopes through duodenoscopes to look at approaching the gallbladder from an internal chemical ablation approach.
At that time there was some early work going on with companies like Olympus that were working on flexible endoscopic systems and early robots - such as a project known as Endo Samurai.
And there were nascent thoughts from the UK like “Endo Snake” coming from Imperial College.
All pretty much doomed for various reasons - especially as many were focused on NOTES rather than NOS. And it was all a bit confused.
Problems were around reimbursement… who would do it? (The endoscopist or the surgeon)… You needed multi specialty teams of endoscopists and surgeons (way too complex and expensive) to do things that we’re being done very adequately by laparoscopic surgery (and growing laparoscopic robots like daVinci.)
No one could understand why on earth you wanted to take a gallbladder out via traversing the stomach. They were right. People were going after the poster child of laparoscopy — it was a bit dumb.
It was often seen as talking something good that worked - and making it super complex and expensive for no good clinical reason.
Some of the techniques have made it more mainstream such as vNOTES (vaginal NOTES) - and a few very small niche procedures. But NOTES was pretty much doomed back then.
Misunderstanding a GoGo
Back in 2007 / 2008 a few things conspired to make this entire venture an issue. Let’s set aside the biggest issue - which was that there was a banking collapse and housing market collapse that destroyed most VC funding for a few years. So a lot of nascent companies went bankrupt.
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