Intravascular Procedures

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Intravascular Procedures

Recent innovations in intravascular procedures stem from advances in both concept and in technology, particularly in the development of endoscopes. Intuitive Surgical's da Vinci robotic system can be credited as a turning point for many of these innovations. In part because of the drive to make procedures as minimally invasive as possible, the global market is expected to nearly double over the next five years.

Innovations in Concept and Devices

Many conceptual advances in vascular and endovascular surgery have been made. Clinical trials comparing stents to endarterectomies have shown stents to be "non-inferior." Fenestrated Endovascular Aortic Aneurysm Repair has been suggested as an effective first-line strategy for certain complex types of aneurysms, as it increases the proximal landing zone. In 2016, new types of endovenous surgery, including treatment for Nutcracker Syndrome, were tried with promising results.

A variety of new endovascular devices have been developed for the treatment of brain aneurysms. A recent report on a three-year study of flow-diverting stents reported "complete occlusion in 93.4% of aneurysms and no recanalization of previously completely occluded aneurysms." New intrasaccular devices include Medtronic's Medina embolization device, designed with filament petals that deform to fill the space within any saccular aneurysm at any location. New bifurcation support devices include phenox GmbH's pCONus device, which has four distal loops designed to support coil embolization of bifurcation aneurysms by flaring to support the coil mass.

Endoscopy has become increasingly useful in the detection and treatment of many gastrointestinal conditions, particularly cancer. Improved endoscopic imaging has enabled better diagnosis of adenomaspolyps, and dysplasia. Clinicians are greatly assisted by high-definition cameras and virtual chromoendoscopy, which allows them to change the contrast of the images they view. New tools and techniques allow clinicians to both highlight and resect polyps. Submucosal endoscopy is now possible, as well, which has led to the development of endoscopic mucosal resection and endoscopic submucosal dissection techniques. Furthermore, higher-quality metrics are now being used.

Innovations in Cameras

In the past, most minimally invasive procedures were done with a rigid endoscope that had a rod-lens-based optical system, which is both delicate and costly. They depended on expensive CCD cameras, which were able to provide "standard video in PAL resolution (in Europe), with 576 lines at 25 frames a second, or NTSC (in the US), with 480 lines at 30 frames a second in an aspect ratio of 4:3."

These CCD cameras have largely been replaced with CMOS sensors, which offer "a resolution of ‘native full high definition’ (full HD with a resolution of 1,980×1,080) at 60 frames a second." Rather than a rod-lens-based optical system (2.7 millimeters), visualization can now be done with fibre optic bundles (of up to 50,000), which can be as small as 1 millimeter in diameter. Beyond this, the lenses at the distal tips of rigid endoscopic cameras are now soldered with gold, which "avoids causing allergic reactions in patients, and is more robust against reprocessing detergents."

Many procedures now depend on a mixture of imaging strategies, such endoscopes combined with CT scans or MRIs. These images also benefit from video algorithms, which can enhance image quality, correct system errors, and highlight specific areas.

Endoscopic cameras have also been influenced by Intuitive Surgical's da Vinci robotic system, which was first cleared by the Food and Drug Administration in 2000 and has gained popularity in recent years; in 2017 alone, Intuitive Surgical's valuation rose by 70 percent to nearly $40 billion. The system has enabled surgeons to perform minimally invasive procedures and has sparked innovation in part because of its movable high-definition 3D endoscopic camera.

Intuitive Surgical's 3D imaging system is now being offered as the handheld HD Aesculap EinsteinVision, which offers chip-in-scope technology. Using chip-in-scope or LED-in-scope technology allows these instruments to operate without separate light sources. In the past, endoscopic cameras used halogen or xenon bulbs (50 hours); now, many cameras use LED light sources (500 hours). These new light sources can also be integrated into the distal tip of the endoscope, although LED-in-tip technology generates a high temperature.

While 4K resolution is now possible for endoscopic cameras, it is both expensive and impractical: "Today, endoscopic towers are usually equipped with a 27–32in monitor, and for the human eye to see 4K resolution in a 32in monitor, the distance between eye and monitor should be around 60cm."

Advances in endoscopic technology also include capsule endoscopes and robot-assisted endoscopy.


The Drive for Advancement

Several reasons explain the rapid advancement of endoscopic technology and support the market's continued growth. The aging baby boomer generation is at risk for many conditions that need endoscopic procedures. Furthermore, endoscopic technology is continually becoming better understood and accepted by medical professionals and patients alike. Finally, patients benefit most from the performance procedures that are as minimally invasive as possible, which supports faster recovery times. For these reasons, Allied Market Research predicts that the market for endoscopy devices will reach $40,854 million by 2022, with North America accounting for 1/3 of the global market.

Conclusion

The use of endoscopic and intravascular procedures is ever expanding. Patients benefit most from procedures that are as minimally invasive as possible, and new technology has allowed for ever-more accurate and precise diagnoses and procedures. The market for endoscopy devices is therefore expected to increase globally over the next five years.
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