最新の内視鏡治療機器―NOTESへの応用―

Latest development to therapeutic device for flexible endoscopy : application to NOTES

◆要旨：軟性内視鏡を用いた治療手技は，早期消化管悪性腫瘍に対する治療を軸に発達してきた．内視鏡的粘膜切除術（EMR）が内視鏡的粘膜下層剝離術（ESD）へと進化を遂げ，その間に内視鏡関連機器は目覚ましい進歩を遂げている．またNOTES（natural orifice translumenal endoscopic surgery）という新概念の登場から，シンプルな軟性内視鏡用縫合機器やNOTES実現へ向けた新技術の開発も進んでいる．本稿では最新の内視鏡治療関連機器，およびNOTESをターゲットとした内視鏡機器に関して概説した．NOTESが今後内視鏡下手術に代わり，臨床の場で定着するかどうかは不確定だが，NOTES研究に伴い開発された種々の新技術が，今後の消化器内視鏡や内視鏡下手術領域の発展に多大に寄与するものと期待されている．

　Therapeutic technologies for flexible endoscopy have been developed with a focus on the treatment of early gastrointestinal tumor. While endoscopic mucosal resection（EMR）has developed into endoscopic submucosal dissection（ESD）, devices for endoscopic treatment have advanced remarkably. Furthermore, the advent of a new concept of endoscopic surgery, NOTES（natural orifice translumenal endoscopic surgery）, has directed the development of suturing devices for flexible endoscopy or multitasking platforms for NOTES procedures. The latest development of devices for flexible endoscopy and NOTES is outlined in this chapter. It is uncertain whether NOTES will replace the conventional laparoscopic surgery and establish as the third generation surgery in the clinical field. However, a variety of development for new technologies for NOTES research is expected to contribute to the progress of the field of gastrointestinal endoscopy and laparoscopic surgery.