Overview of Endoscopy and Micro-Endoscopy

Endoscopy, according to Dorland’s Medical Dictionary, is the science of “visual inspection of any cavity or area of the body by means of an endoscope.” Micro-endoscopy is the science of carrying out such inspections in a minimally invasive or endoluminal manner, such that the risks associated with traditional endoscopies (discomfort, bleeding, infection) are minimized. Thus, micro-endoscopy is a critical enabler of the minimally invasive and endoluminal medical procedures that are increasingly providing better care and patient outcomes across a range of medical fields.

Many technical parameters crucially impact the success of any given micro-endoscope technology. Choices of optical image and light-source fiber materials, light source design, focusing system structures and materials, manufacturing processes, and other factors determine the level of image and micro-visualization quality that can be achieved at a given endoscope diameter.

The frontiers of minimally invasive and endoluminal medicine require ever-greater miniaturization of optical technology, ideally with as little sacrifice as possible of the image quality available to surgeons doing traditional, more invasive procedures. The BioVision team has a quarter-century of experience in pushing the limits of the possible in terms of image quality for extremely small diameter endoscopes (1.2mm outer diameter and below, down to 0.4mm outer diameter and perhaps smaller). Please contact us to discuss how our imaging technology can help enable your minimally invasive or endoluminal medical procedures.

“Virtual endoscopy?”

There is much talk today of so-called “virtual endoscopy,” of diagnosis based on 2D or 3D images of the interior of human organs generated using computer processing of digital datasets generated by external scans, such as CTs and MRIs. Are these the future of minimally invasive medicine? We think not.

ACTUAL endoscopy allows a clear, real-time view for the physician performing a procedure, a view that can be adjusted and manipulated throughout the procedure to optimize physician performance and patient outcomes.

By contrast, as of today, the images provided by computer simulated “virtual endoscopies” are static, and far inferior in ability to discriminate between small shapes (is that a normal tissue irregularity, or a polyp or tumor?). Even as the quality of computer simulation continues to improve, internal imaging created digitally based on external scans will always have a number of key limits:

The technology required (extremely expensive scanning devices, high-performance computers needed to crunch the complex algorithms that generate the simulated images) will likely always limit the venues in which such procedures can take place; these are not going to be applications relied on in doctors offices, ERs, and the like
There will likely always be uncertainties about the ability of external scans to discriminate at the most micro-level, and thus attendant liability concerns (if, for instance, an examiner misses in a “virtual” scan a precancerous polyp that would have been caught via traditional endoscopy). This will tend to lead to high levels of “double examinations” – with patients undergoing external scans, only to be quickly referred for traditional exams based on even the slightest irregularity.

Most crucially:

External scans can only simulate an image (in most cases a static image) of the interior of the human body; they do not create an opportunity to manipulate the objects seen. Thus, at best, “virtual endoscopy” is a diagnostic technology. It does not now and likely will not in the future have a place in therapeutic or surgical applications.

As the leader in micro-visualization solutions, based on micro-endoscopy, that enable minimally invasive and endoluminal medicine, BioVision welcomes your questions or concerns.

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