MEDICAL
BUSINESS
Olympus Medical BusinessOUR PURPOSE

Making people’s lives healthier, safer and more fulfilling
OUR CORE VALUESPATIENT FOCUS

INTEGRITYINNOVATIONIMPACT

EMPATHY

We put patients at theheart of everything.

We do theright thing.

We look for new ways
to make things better.

We take accountability
and get things done.

We care for one anotherand work together.

Introduction
Olympus developed the world ’s first practical gastrocamera
in 1950. This innovative device contributed greatly toestablishing methods for the early diagnosis of stomach
cancer, a kind of cancer that had previously been a leading
cause of death in Japan. Since then, Olympus has strived tomake further developments with the use of endoscopes forvarious forms of examination and treatment.
Advancements in minimally invasive treatments arecontinuously being made within the medical field. Olympus
provides products/solutions to treat various diseases — not
only in gastroenterology, but also urology, respiratory,s pain andetc. — which contribute to reducing the patient ’suffering. They also help to improve patients' quality of life
(QOL) and reduce medical costs by spending shorter times
in hospital and returning to normal life more quickly.
By publishing“ The Olympus Medical Business ”we hopeto provide our investors, shareholders, and otherstakeholders with a general understanding of the Medical
Business of Olympus. We will also introduce recent trends
in our medical devices for diagnosis and treatment.
Investor Relations, Olympus Corporation

Contents
The Olympus Medical Business
02 Early Diagnosis and Minimally Invasive Treatment
04

The Social Issues Solved by Olympus

06

Outline of Endoscopic Solutions Division (ESD)08

Outline of Therapeutic Solutions Division (TSD)

10

Features of ESD

18

Features of TSD

23

TOPIC: Single-use Endoscope

Appendix
24

Main Diseases, Procedures, and Products
24 GI
31 Urology
32 Respiratory
34 Ear, Nose, and Throat (ENT)35

Structure and Components of Endoscopes

38

The History of ESD

42

The History of TSD

45

The History of the Olympus Medical Business

Forward-Looking Statements“ The Olympus Medical Business ”contains forward-looking statementss current views, plans, and expectations based onthat reflect management’

information available at the time of preparation. These forward-looking
statements are not guarantees of future performance and involve known
and unknown risks, uncertainties, future business decisions, and others actual results,
internal and external factors that may cause the Company ’performance, achievements, or financial position to be materially different
from any future results expressed or implied by these forward-looking
statements.

About ProductsSome products in“The Olympus Medical Business”have not yet beenreleased in some regions.

01

The Olympus
Medical Business

Early
Diagnosis

Endoscopic
Solutions D ivision

Therapeutic
Solutions Division

By incorporating technology aimed at improving the quality of lesion detection,
diagnosis, and treatment, as well as examination efficiency, gastrointestinalendoscopes, which are one of Olympus’mainstay products, contribute to the early
detection of lesions from gastrointestinal diseases such as cancer.
If a suspicious lesion is found during the endoscopic examination, the area can be
sampled for pathological examination.
Recently, our endoscopes’magnification function is expected to enable doctors tomake a definitive diagnosis immediately based on magnified images without the needto damage body tissue.

Detection

Gastrointestinal endoscopy
systems

02

Diagnosis

Biopsy/Collection

Magnifying endoscopes

Biopsy forceps

Ultrasound endoscopes

Cytology brushes

Olympus' Medical Business is divided into two divisions: Endoscopic Solutions Division (ESD), which deals withgastrointestinal endoscopes, surgical endoscopes, and medical services, etc.; and Therapeutic Solutions Division(TSD), which mainly deals with medical devices for GI EndoTherapy, urology, and respiratory. With a variety of
products and services developed from these two businesses, we will provide the two values of early diagnosis
and minimally invasive treatment. Through this, we hope to contribute to improvements in the QOL of patients
while also helping to address the worldwide trend of rising healthcare costs.

Minimally
Invasive
Treatment

Gastrointestinal endoscopes can also be used together with endotherapy devices totreat early-stage cancers, as well as various treatments such as removal of polyps andaccidental foreign objects.
In the field of urology, we are deploying devices that can be used in clinics to treat
benign prostatic hyperplasia (BPH), which is expected to increase with the aging of the
population, without the need for excisional surgery. It is a minimally invasive treatment
s body.
that ensures no permanent foreign object remains in the patient ’
Unlike conventional open surgery, endoscopic surgery (laparoscopic surgery) does not
require large abdominal incisions therefore patients are expected to feel less postoperative pain, spend shorter days in hospital and return to normal life more quickly.

Endoscopic therapy

Endoscopic surgery

Other minimallyinvasive treatment

Minimally invasive treatment devices
for BPH

SnaresSurgical endoscopy systems

Electrosurgical knives

Thulium fiber laser systems
Surgical energy devices

03

The Social Issues Solved by Olympus
Olympus developed the world ’s first practical gastrocamera tofulfill the wishes of doctors who had said they wanted some
way to cure stomach cancer. Since then, we have beenworking together with doctors to improve endoscopic
technology and enhance diagnostic and therapeutic methods.
Responding to the needs of endoscopists, our advanced
technologies continue to be at the forefront of the industry,World's First
practical
gastrocamera

70 %Global market shareof gastrointestinalendoscopes* 1

and represent just one of the advantages of our products.
Currently, we boast a global market share of about 70% for
our mainstay gastrointestinal endoscopes.

*1 As of November 2022

Endoscopes play an important role in detecting and treating
many types of cancer. For example, according to 2020 data,
new cases of colon cancer affect about 1.9 million people
annually, and it is reported that about 0.9 million of those cases
are fatal, a number that is expected to increase in the years to
come.
Colon cancer has a much higher probability of being cured
if found in the early stages, when the cancer has not yet

1.9 million

51 million

colonoscopies are performed annually for the diagnosis andNew incidents ofcolon cancer* 2

Colonoscopies
performed worldwide* 3

therapeutic treatment of colon cancer, and Olympus products*2 Data source: GLOBOCAN 2020*3	Numbers of the US, Canada, Poland,South Korea, Australia, India, andRussia: As of 2022
Japan: As of 2020
	China, Germany, France, Italy, Spain,
the UK: As of 2019spread. However, early-stage colon cancer often has no
subjective symptoms, and thus cancer screening is very
important for early detection and treatment. About 51 million

are used for many of them.

Moreover, endoscopes are used not only for detecting anddiagnosing lesions, but also for their therapeutic treatment. In
addition to endotherapy devices equipped on gastrointestinalendoscopes we provide versatile medical devices for various
hospital departments, such as urology and respiratory, and ourdevices are capable of treating about 100 diseases.
By providing treatment methods for three of the five

100

TOP 3

Diseases orconditions treated* 4Cancers treated* 5cancers with the highest number of cases — lung, colon, andstomach* 5— and developing therapeutic devices to help treat
other cancers, Olympus is contributing to the health of people
around the world.
*4 As of March 2023
*5	As of March 2023. Data source: GLOBOCAN2020 Top 3 highest incidence of caners
excluding breast and prostate cancer04

〈Reference Data〉

Data source: GLOBOCAN 2020 ©International Agency for Research on Cancer 2021

BreastNumber of Cancer Cases in the World by Cancer Site

Lung

Estimated number of incident cases and deaths worldwide for both sexes and all ages

Colon
Breast
Prostate
Lung
StomachColon
Liver
Prostate
Cervix uteri
StomachEsophagus
Liver
Thyroid
Cervix uteri
Bladder
Esophagus
Thyroid

罹患者数

死亡者数
罹患者数

死亡者数

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

Incidence

BladderMortality0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

Number of Cancer Cases in the World by Country
Estimated number of incident cases and deaths worldwide for both sexes and all ages
China
U.S.
India
China
Japan
U.S.
Germany
India
BrazilJapan
RussiaGermany
FranceBrazilUK
RussiaItaly
France
UK

罹患者数

死亡者数
罹患者数

死亡者数

Incidence
Mortality01,000,000

2,000,000

3,000,000

4,000,000

5,000,000

01,000,000

2,000,000

3,000,000

4,000,000

5,000,000

Italy

Number of Cancer Patients

Number of Deaths from Cancer(2020/2040 comparison)(2020/2040 comparison)

Estimated number of new cases from 2020 to 2040 for both sexes
and all ages (All cancers, World)

Estimated number of deaths from 2020 to 2040 for both sexes
and all ages (All cancers, World)

2020

2040

19.3 million 30.2 million

2020

2040

9.96 million 16.3 million

500,000

Demographic
changes05

Outline of Endoscopic Solutions Division (ESD)In the ESD, we contribute to the medical field with a variety of products and services,
including endoscope systems, scopes (flexible and rigid), and medical services.

GI Endoscopy
Gastrointestinalendoscopy systems

A group of products for inserting endoscopes into the digestive organs throughnatural orifices (mouth, nose, anus) for observation and diagnosis

Esophagus/Stomach

Gastrointestinal videoscope:
Inserted through mouth/nose

Duodenum/Biliary tract

Gastrointestinal endoscopy systems
Duodenovideoscope/Cholangiovideoscope:
Inserted through mouth

Flexible endoscopes
Suitable for examination andtreatment of internal organs byutilizing the flexibility of theinsertion tube and distal end toinsert the scope through themouth or nose, for example

Small intestine

Large intestine

Small intestinal videoscope:
Inserted through mouth/anusColonovideoscope:
Inserted through anus

Please refer to pages 25 and 29 for details of the devices.

Reprocessing〈Main usage scenes〉 Example of Endoscopic Examination
Flexible
Endoscopes

Endoscope reprocessors

Please refer to page 56 of theIntegrated Report 2023 for details.

06

Gastrointestinal Endoscopy
Systems

Please refer to page 35 for outline ofgastrointestinal endoscopy system

Surgical Endoscopy

Endoscopy products that are mainly inserting into the abdominal cavity
through a small hole on the body surface to check the condition of theinside body during surgical operations and microscope system

Brain

Surgical endoscopy
systems

Ventricular endoscope

Neurological endoscope

Peripheral, Abdominal and Thoracic
Surgical endoscopy systems

Rigid endoscopes

Laparoscope/Thoracoscope

Rigid endoscope

Suitable for laparoscopic
surgical procedures, such as
laparoscopy and cystoscopy,
using a rigid endoscope madefrom a lens contained in a metal
tube

Joint

Arthroscope

Customer Solutions〈Main usage scenes〉 Example of Laparoscopic Surgery（Digital Healthcare Solutions ）Rigid
Endoscopes

Surgical Endoscopy
Systems
Please refer to page 36 for outlineof surgical endoscopy system

Customer solutions
virtual collaboration

Medical Service

General repairs and service contracts for endoscopy system

General repairs
Repair services through repair bases worldwide
Repair services at facilities through field services (stationary
equipment such as reprocessors)Service contracts
Single-year or multi-year contracts
Partial or complete repair cost coverage
Priority provision of loaners during repair of defective products
Provision of failure prevention training
Provision of comprehensive services

Repair center07

Outline of Therapeutic Solutions Division (TSD)
Our portfolio in the TSD includes a wide range of endotherapy devices, endoscopes,
and therapeutic devices for urology, respiratory, ENT, gynecology, and surgical energy
devices. The various products are helping to prevent, diagnose, and treat diseases.

A group of products that are inserted into the instrument channel of flexible
endoscopes and used for various endoscopic procedures. They can be used
for tissue sampling, lesion removal, and hemostasis without making incisions
or small holes on the patient ’s body surface

GI EndoTherapy
Endotherapy devices

Resection of the lesion, Hemostasis

Tissue sampling for diagnosis

Biopsy forceps

ElectrosurgicalsnareElectrosurgicalknife

Hemostasis clip

Stone removal, Bile drainage

Guidewire

Stone extraction
balloon

Papillotome

Stone retrieval basket

Plastic stent

Please refer to pages 26-30 for details of the devices.

〈Main usage scenes〉 Examples of Endoscopic Examination

Endotherapy
Devices08

A group of urology products for observing, diagnosing and treating the urethra, prostate,
bladder, ureter and kidneys by inserting endoscopes transurethrally or percutaneously.
Also, a group of gynecology products for observation, diagnosis, and treating the uterus
by inserting endoscopes and instruments transvaginally

Urology
ScopesUterusUrinary system

器具選択をたすけるカラーコード表示。

み合わせがひと目でわかるように、識別容易なカラーコード表示を徹底。光学視管にカラードットで色分け表示し、シース・マンドリンには太さ別にカラードットが施さ

視野方向

カラーコード

赤
黄
橙※
※

光学視管

カラーコード
白
青
桃
橙
緑
茶

青

カラーコードシース外径

カラーコード
白
青
桃
橙
緑
茶

緑
青
赤
黄
橙※
※

膀胱尿道鏡システム。

高性能はそのまま継承し、更に細かな点に配慮して、挿入性・操作性を向上させました。
先生方に使いやすさをご提供いたします。

以前の製品は白膀胱尿道鏡組み合わせ表※ブリッジ組み合わせの場合、使用可能鉗子径および本数を表記しています。

使いやすさを追求し、更なる進化をとげた

シース・マンドリン

視野方向以前の製品は白※ブリッジ組み合わせの場合、使用可能鉗子径および本数を表記しています。

サイズ
サイズカラー
光学視管
ストレート
観察専用

チーマン
観察専用

ッジ

なし）

シース外径

緑

器具選択をたすけるカラーコード表示。
適切な器具の選択、組み合わせがひと目でわかるように、識別容易なカラーコード表示を徹底。光学視管には視野方向を側面のカラードットで色分け表示し、シース・マンドリンには太さ別にカラードットが施されています。

シース・マンドリン

チーマン
×

観察のみ

観察のみ

観察のみ

×

観察のみ

観察のみ

× 、

観察のみ

×

× 、

×

観察のみ

観察のみ

× 、

観察のみ

×

×

×

×

×

×

× 、

×

観察のみ

生検

生検

生検

生検
（通電）

生検
（通電）

生検

生検

生検

生検

Ureteroscope/
Cystovideoscope

生検
生検
異物摘出

異物摘出

異物摘出

チーマン
観察専用

チーマン
×

へーベル付きブリッジ（ 孔）

× 、

×

× 、

観察のみ

観察のみ

観察のみ

観察のみ

×

観察のみ

観察のみ

× 、

観察のみ

観察のみ

観察のみ

×

異物摘出

Rigid cystoscope

Resectoscope

）

（

）

（

）

（
（

）
）

×

×

×

×

× 、

×

×

×

×

×

×

観察のみ

観察のみ

× 、

×

×
×

観察のみ

×

×

膀胱尿道鏡

形状は最小に、観察・処置性能は最大に。
二律背反を解決する高性能システム。

生検

生検

生検

把持鉗子
（

チーマン

×

×
×

チーマン
ガイド溝付

チーマン

チーマン
×

×
× 、

生検鉗子

把持

生検
生検
（通電）

ストレート
観察専用

へーベル付きブリッジ
）

（ ）
（ ）
ブリッジ（鉗子孔なし）
（ ）
（
）
（ ）
（
）

生検

把持

把持

）

ブリッジ
（ ）
（ ）
（ ）
（
） ブリッジ（ 孔）
（ ）

膀胱尿道鏡

形状は最小に、観察・処置性能は最大に。
二律背反を解決する高性能システム。

生検

）

×

×

観察のみ

観察のみ

（
（
（

×

× 、

×

シース形状

×

×
×

×

シース型式名

チーマン

×

×
×

チーマン
ガイド溝付

チーマン

チーマン
×

×
× 、

シストスコープ

把持

把持

把持

生検鉗子

生検

生検

生検

生検鉗子

生検（通電）

生検（通電）

生検
（通電）

生検鉗子

生検

生検

生検鉗子

生検

生検

ステンレススチールやテフロンなどの新素材の採用

生検
生検

異物鉗子

異物摘出

異物鉗子

滑らかな先端形状

異物摘出

異物摘出

異物摘出

処理用光学視管仕様
視野方向チャンネル径formation

使用可能鉗子径

外径
製造販売元 オリンパスメディカルシステムズ株式会社
医療機器番号

人間工学設計によるコントロールレバーとブレーキシステム

医療機器番号
膀胱尿道鏡
持続灌流式膀胱尿道鏡用ブリッジ

光学視管

光学視管

持続灌流式膀胱尿道鏡用シースセット

把持鉗子（軟性）
鋏鉗子
アダプター
砕石鉗子
、電極

、電極

、電極

、電極

持続灌流式膀胱尿道鏡用シースセット

Therapeutic devices

膀胱尿道鏡異物鉗子（軟性）生検鉗子（軟性）、電極

使用可能鉗子径

レゼクトスコープ

持続灌流式膀胱尿道鏡用ブリッジ、電極

チャンネル径

販売名

膀胱尿道鏡
レゼクトスコープ

高周波電極 （電極

視野方向

製造販売元 オリンパスメディカルシステムズ株式会社

販売名）

What Is PLASMA?

Open Ordering Information

膀胱尿道鏡
異物鉗子
（軟性）
生検鉗子
（軟性）
鋏鉗子
アダプター
砕石鉗子
高周波電極 （電極

Plasma resection for
BPH and NMIBC*

、電極

、電極

、電極

、電極

、電極

、電極

）

Please refer to pages 31-32
for details of the devices.

Urinary system

What Is PLASMA?

レーザーシストスコープ

把持鉗子
（軟性）

Minimally invasive
treatment device for BPH

チャンネル径を用意。
各種レーザープローブに適用するので、用途に応じてお使いいただけます。

十分な持続灌流によりクリアな視野を確保。

Thulium fiber
laser system*Non-Muscle-Invasive Bladder Cancer

A portfolio of flexible endoscopes and single-use devices to visualize, diagnose andtreat diseases in the tracheobronchial tree

Respiratory
ScopesEndotherapy devices

Tracheobronchial tree

Bronchovideoscope

Tracheobronchial tree

Biopsy forceps

Endobronchial valve

Please refer to pages 32-33
for details of the devices.

Other Therapeutic Areas
ENT

Surgical Devices

A group of products for observation, diagnosis, and treating the nasal
cavity, oral cavity, pharynx, larynx, and ears by inserting endoscopes
through the nose, mouth, and ears

Broad offering of energy-based devices that enable
laparoscopic and open surgical procedures by
providing tissue grasping, manipulation, dissection,
coagulation & vascular control

Please refer to pages 34 for details of the devices.

Op

en

Ord

eri

ng

Info

rm

ati

Please refer to pages 37 for details of the devices.

Scopes

Therapeutic devices

Surgical energy devices

Ear, Nose, and Throat

Ear, Nose, and Throat

Peripheral, Abdominal and Thoracic

DebriderSurgical tissue management system

on
Wh

at

Is

PL

AS

MA

?

Rhino-Laryngo videoscope

Rigid scope

09

ESD
Endoscopic Solutions Division
In its Endoscopic Solutions Business, Olympus uses innovative capabilities inmedical technology, therapeutic intervention and precision manufacturing to help
healthcare professionals deliver diagnostic, therapeutic and minimally invasive
procedures to improve clinical outcomes, reduce overall costs and enhance thequality of life for patients and their safety. Starting with the world s firstgastrocamera in 1950, Olympus Endoscopic Solutions portfolio has grown to
include endoscopes, laparoscopes, video imaging systems, as well as system
integration solutions and medical services.

10Features of ESD

01

Competitive productdevelopment

Market scale and growth forecast of
GI Endoscopy

GI Endoscopy¥ 300 – 400 billion● From the time when Olympus developed thes first practical gastrocamera in 1950
world ’
to today, Olympus has continued to refine its
endoscope technologies in close
collaboration with physicians● Developing technologies that contribute to
the improvement of the quality of endoscopy
around the world, such as NBI, RDI, TXI, and
EDOF● Providing high-definition and high-quality
products with 4K/3D technology● Acquisition of advanced fluorescence imaging
technology and promotion of research anddevelopment toward next-generation
molecular imaging technology

Market CAGR 4 – 6%Market Share

No.1

Approx. 55% of
ESD revenue
Note: Served market scale and growth forecast information for this page comefrom the Company’s research and pertains to data for the U.S., EU5(Germany, UK, Italy, France, Spain), Japan and China, Market scale is asof March 31, 2023, Growth forecasts are projected for fiscal year 2023 to
fiscal year 2026. The Sub-segment sales ratio within ESD is a figure of
fiscal year 2023.

02

Solid business foundations

1 Global service
network

2 Support training
endoscopists

3 Craftsmanship for
meeting physician
needs

Established a global network ofservice locations: Europe, theAmericas, Middle East, Africa,
Japan, China, and Asia, which is
the largest network of service sites
for any global medical device
manufacturer

Supporting training for endoscopists
by opening training centers in China
and other Asian countries, where
demand for early diagnosis andminimally invasive treatment is
expanding along with the economic
growthProviding more than 300 types ofendoscopes through advanced
manufacturing technology andhigh-mix, low-volume production tomeet diversifying customer needs

Large endoscope repair center

Olympus China Medical Training &Education Center Shanghai(C-TEC Shanghai)

Endoscope11

01

Competitive product development

GI Endoscopy
Past
The Birth and Spread of Gastrocamera
At the department of surgery, the University of Tokyo Branch Hospital, with the support ofAssistant Professor Takeo Hayashida, Dr. Uji and the Olympus technical team developed
an experimental gastrocamera. This gastrocamera was launched in 1952 as the“GT-I
Gastrocamera.”However, as there were a number of problems with the early product andimaging techniques had not been well established, it did not catch on. Gastrocamera
operations ran a deficit, and there were discussions at Olympus as to whether thebusiness could continue on as it was. Amid this, the first place to recognize the potentialof the gastrocamera and make an effort to popularize it was in the #8 ResearchLaboratory of the University of Tokyo Main Hospital First Department of Internal Medicine(Tasaka Internal Medicine Department: Professor Sadataka Tasaka).
The Tasaka Internal Medicine Department first assisted Olympus by offering advice
regarding problems with this early instrumentation from a user's point of view. But thegreater topic at the time was the need to establish a standardized technique forphotographing the inside of the stomach. The gastrocamera differs from the fiberscope inthat the doctor cannot directly observe the inside of the stomach during the examination.
It is exceedingly difficult to get a satisfactory image while blindly maneuvering the
instrument around inside the stomach.
In order to determine the location of the gastrocamera in relation to the various partsof the stomach, various daunting tasks had to be repeated, such as using X-rays andrecording the gastrocamera's degree of insertion, twisting of the shaft and noting theresult, and measuring the amount of air flow required to optimally insufflate the stomach.
Through these experiments, a standardized imaging technique was established around1956.
The role of the“Gastrocamera Research Group”(currently the Japan
Gastroenterological Endoscopy Society), as first established and centered around theTasaka Internal Medicine Department, cannot be forgotten. The first meeting of the
Gastrocamera Research Group was held in 1955, and research reports focusing on
cancer were presented. At the fifth research society meeting in 1958, there were 16
presentations and 200 attendees, and research had progressed to the clinical stage.
Along with Olympus as the manufacturer, the group established the Technology
Committee (afterward the Gastrocamera Promotion Committee) in 1955. Once a month,they met to share opinions regarding failure prevention and device improvements. These
efforts became the driving force behind the spread of the gastrocamera.

Dr. Uji (center), attending a clinical trial

First Gastrocamera Research Group meeting(at the podium, Professor Tasaka)

Present
Image-enhanced Endoscopy and NBI
The gastrocamera, developed by Olympus in 1950, greatly influenced early-stage stomach cancer diagnostics. Through theaccumulated research that followed, it was understood that early-stage lesions could be found through slight differences in the color of
mucosal surfaces within the digestive tract. A technique called“chromoendoscopy,”spread rapidly starting in the 1970’
s. Thisprocedure sprays various dyes on the tissue lining the GI tract in order to detect subtle lesions that are hard to detect using normal
endoscopic imaging. Olympus expanded upon these principles and developed a technique called Narrow Band Imaging (NBI) that isdesigned to reveal subtle lesions through an optical method. NBI is one example of an imaging enhancement technique that uses a
combination of optical and digital methods (opto-digital).
Narrow Band Imaging (NBI)
Olympus developed Narrow Band Imaging technology toenhance observation of mucosal tissue. NBI is an opticalimaging technology that enhances the visibility of vessels andother tissue on the mucosal surface. NBI works by filtering thewhite light into specific light wavelengths that are absorbed byhemoglobin and penetrate only the surface of human tissue.
As a result, with Narrow Band Imaging, capillaries on themucosal surface are displayed in brown and veins in the
submucosa are displayed in cyan on the monitor.

12① Blue light : Strongly absorbed by hemoglobin in capillaries

near the tissue surface, and not reflected.

② Blue light : Strongly reflected by the mucosal surface layer.
③ Green light : Strongly absorbed by hemoglobin in bloodvessels deeper in the tissue, and not reflected.

④ Green light : Strongly reflected by the tissue beneaththe mucosa.

⑤ A well-resolved image is produced by utilizing both reflected

and non-reflected

Monitor screen in NBI mode
Capillary in mucosal
surface layer
Larger blood vesselin tissue below mucosa

Brown : Capillary in mucosal surface layer
Blue : Larger blood vessel in tissue below
mucosaInnovative Imaging Technologies
In 2020, we launched the EVIS X1, the latest model of our endoscopy system. As of February 2024, thesystem is marketed in Japan, U.S., Europe, China and parts of Asia. This model is equipped with thefollowing three imaging technologies that will further improve treatment and diagnosis. It contributes to early
detection, early diagnosis, and minimally invasive treatment of gastrointestinal diseases such as cancer.
EVIS X1TXI Texture and Color Enhancement Imaging
TXI supports better visibility of potential lesions (such as areas of inflammation, flat or depressed lesions, or even tiny
precursor lesions) through enhancing texture, brightness, and color to define subtle tissue differences more clearly. With its
advanced imaging technology, TXI holds the potential to reinvent white light in endoscopy. By supporting better visibility ofpotential and extant lesions, TXI aims to contribute to higher detection rates and improve qualitative diagnosis.
TextureTexture enhancement

Color tone enhancement

Image processing
operation

Synthesized

Separated

Normal lightobservation

After TXIBaseBrightness enhancement/Correction

RDI Red Dichromatic Imaging
Gastrointestinal bleeding is a serious challenge, potentially involving
considerable mortality risks and management costs. RDI enhances
the visibility of deep blood vessels and gastrointestinal bleeding
sources, thereby helping to identify blood vessels that could require
immediate treatment. It utilizes green, amber, and red wavelengths tovisualize deep blood vessels. Easier identification of bleeding spots
makes hemostasis quicker and easier while potentially improving theefficiency of any corresponding treatment. This minimally invasive
technology could also be expected to help reduce physician stressduring endoscopic therapy.

EDOF Extended Depth of Field
EDOF combines two images at different focus distances into one
perfect image to help aid diagnosis and confidant decision-making. It
delivers observational excellence through continuous broad focus andseamless magnification. At the same time, the established Dual Focus
function provides high magnification, which can be activated by thepush of a button. This improved visibility and continuously sharp
image has been developed to reduce the necessity for focal
adjustments and could be expected to improve efficiency anddecrease the oversight rate.

Dual Focus

Reflector 1 Reflector 2
EDOF

Beam splitter

Image sensor
Forms two different
images simultaneously

13Surgical Endoscopy
4K, 3D, and Infra-Red Imaging
We established Sony Olympus Medical Solutions Inc., a joint venture with Sony
Corporation, in 2013. Sony Olympus Medical Solutions is engaged in the researchand development of new products that combine Sony's cutting-edge electronics
technologies in areas such as digital imaging with Olympus' manufacturing and
R&D expertise in the area of medical products including lenses and opticaltechnologies.
● Surgical Endoscopy System that Supports 4K, 3D andInfrared (IR) Imaging Features
Olympus launched VISERA ELITE III in 2022. Not only does the system enable useof 4K, 3D, infra-red (IR) imaging, NBI observation modes, and further options tomeet surgeons’needs, it is also compatible with Olympus’existing rigid scopes,
flexible scopes, and camera heads. Furthermore, the system software can be
upgraded allowing for additional functions, and the system as a whole can be used
in a wide range of clinical areas including general surgery, urology, gynecology, andEar, Nose and Throat (ENT) surgery. VISERA ELITE III enhances the quality ofendoscopic surgery, contributes to improved efficiency in the operating room, andelevates the standard of care.
As of February 2024, the system is marketed in Japan, Europe, and parts of Asia.

VISERA ELITE III

Present
Fluorescence Imaging
In 2021, we expanded our portfolio in the growing fluorescence imaging market in thearea of surgical imaging with the acquisition of Quest Photonic Devices B.V., a Dutch
medical device manufacturer.
● Imaging System for Fluorescence-guided Surgery

Fluorescence imaging refers to special light imaging technologies that utilize theproperties of fluorescent dyes directed to specific anatomical structures. By using
targeted dyes, in combination with specific light wavelengths, tissues or lesions thatare nearly invisible under normal white light become visible.
We have added Spectrum® to our portfolio, a fluorescence-guided surgical imaging
system for both open and laparoscopic surgery.

Spectrum ®

FutureMolecular Imaging
Research on molecular imaging technology to visualize cancer lesions using fluorescent drugs combined with antibodies
that specifically bind to cancer is currently underway and is expected to be put to practical use. Quest Photonic Devices
B.V., works with biotechnology companies that are developing next-generation molecular imaging dyes. These innovativedyes may enable Quest Photonic Devices B.V.’s technology to advance diagnostic opportunities in fluorescence-guided
cancer surgery.

14

02

Solid business foundations

1 Global service network

Olympus Winter & Ibe GmbH (OSTE)
Germany(Hamburg)

Olympus Czech Group, s.r.o.
Regional Repair Centre
Czech(Prerov)

Olympus Europa SE & Co. KG
Medical Repair Service EMEA, Regional Repair Centre
Germany(Hamburg)

Olympus Moscow LLC
Russia(Moscow)

Olympus Korea Co., Ltd.
Korea(Incheon)

Gyrus ACMI, Inc. (OSTA National Service Center West)
United States of America(San Jose)

Olympus Medical Systems
India Private Limited
India(Gurgaon)

Shirakawa Olympus Co., Ltd.
Shirakawa Medical Equipment Service Operation Center

Gyrus ACMI, Inc. (OSTA National Service Center East)
United States of America(Bartlett)

Nagano Olympus Co., Ltd.
Nagano Medical Equipment Service Operation Center

Olympus Canada Inc.
Canada(Toronto)

Olympus France S. A. S.
Regional Repair Centre
France(Paris)

Olympus Trading (Shanghai) Limited
China(Shanghai)
Olympus Service Facility Portugal– Tecnologias Opticas e Digitais, Lda.
Regional Repair Centre
Portugal(Coimbra)

Olympus America de Mexico, S.A. de C.V.
Mexico(Mexico city)

KeyMed (Ireland) Ltd.
Ireland(Dublin)

Olympus Hong Kong and China Limited
China(Hong Kong)

KeyMed (Medical & Industrial Equipment) Ltd.
Regional Repair Centre
UK(Southend-on-sea)

Olympus MEA FZ-LLC
UAE(Dubai)

Olympus (Thailand) Co., Ltd.
Thailand(Bangkok)

Olympus (Malaysia) Sdn. Bhd.
Malaysia(Selangor Darul Ehsan)

Olympus Singapore Pte. Ltd.
Singapore(Singapore)

Olympus (Guangzhou) Industrial Co., Ltd.
China(Guangzhou)

Olympus Medical Systems
Vietnam Co.,Ltd.
Vietnam(Ho Chi Minh)

Olympus Australia Pty Ltd
Australia(Melbourne)

Olympus New Zealand Limited
New Zealand(Auckland)

Olympus Optical do Brasil, Ltda.
Brazil(Sao Paulo)

Map of Olympus’repair locations around the world ( ● shows locations capable of major repairs*) (As of April 2018)

Endoscopes are precision instruments used within the human body. High-quality, after-sales service is necessary to maintainsafety and provide maximum functionality. In order for patients around the world to receive safe endoscopic examinations
and treatment, Olympus has established the industry's leading global repair and services system. In addition, we haveestablished a system in which each repair site can provide mutual backup in the event of an emergency such as a disaster.

The World's Largest Endoscope Repair Center (San José, California, U.S.)
Olympus is proud of the“ San José National Repair Service Center, ”which is the world ’slargest endoscope repair center. Within the walls of the 80,000 square-meter building
accented in blue, Olympus ’corporate color, 450 service staff members dressed in whitelab coats meticulously carry out their repair work. The San José location was establishedin 1979 to perform concentrated, authentic repairs (major repairs)*, including full
instrument disassembly and reassembly. Prior to this, major repairs of endoscopes had
been performed at small service locations distributed throughout the U.S. However, it was
decided that a centralized location where high-quality repairs coexisting with rapid repair
turnaround was critical for the U.S. market. The centralization of major endoscope repair
in one facility has improved both the quality and the efficiency of delivering repair services
to our customers.

High Repair Quality
Endoscopes, which are inserted directly into the human body, must meet strict safety andperformance standards. This applies both to new instruments and instruments being returned
to healthcare professionals following service. Therefore, it is required that fully repaired items
have the same level of quality as new products. "Safe, stable use" is one of the essential valuesof endoscopes. With this kind of thinking, Olympus has continued to strive to enhance its
service system, ever since the start of the endoscope business in 1952.

World's largest endoscope repair center(San José, California)*Major repairs: An overhaul involving the dismantling, inspection, and repair of malfunctioning equipment

15

2 Supporting endoscopist training
Demand for early diagnosis and minimally invasive treatment is expanding along with the rapid economic growth in China
and other Asian countries. Like in Japan, the U.S., and Europe, Olympus actively supports training for endoscopists byproviding training opportunities on the safe and effective use of Olympus products, which allows doctors to be familiar withnew products and procedures in China and other Asian countries.
Efforts in China
In addition to the progress which the Chinese government is making in reforming medical care,‘s population is also rapidly aging in a manner similar to U.S. and European countries.
China
In medical facilities, therefore, the number of endoscopists are unable to keep up with thegrowing number of patients, making the development of new endoscopists an urgent matter.
In 2008, Olympus built the China Medical Training & Education Center Shanghai in the researchand industry development district outside of Shanghai in China. This site is conveniently locatednear Shanghai Airport, making it easy for doctors to visit from all over China. Behind the futuristic
exterior of the building are located both a training center and a call center. The training center is
set up to allow for the training of gastrointestinal endoscopic examinations, as well as training
on the operation of endotherapy devices and surgical products. A lecture hall capable of seatingclose to 100 people is located on the uppermost floor and is wired for high-capacity broadband
communications, making academic exchange possible for doctors both inside and outside China.
Training of sales representatives and repair and service technicians is also performed at
China Medical Training & Education Center Shanghai, which contributes to improving thequality of Olympus’marketing services. The call center handles communications with medical
facilities, sales representatives, repair technicians, and dealers throughout the country, withan equivalent level to that of Japan, U.S., Europe. Olympus opened similar training centers
in Beijing in 2010 and in Guangzhou in 2013, further accelerating support for training new
Chinese endoscopists. Based at the three in-house training centers, as well as at collaborative
training centers affiliated with nationwide, Olympus is supporting training for endoscopists
throughout China by providing a range of learning programs. Olympus also invites Japanese
doctors to China who tutor Chinese trainers. Most recently, we have been supporting
Japanese doctors who provide online lectures on the activities of Chinese trainers andevaluate as well as comment on case presentations. Through these and other efforts,
Olympus has achieved remarkable growth in recent years.

Olympus China Medical Training &Education Center Shanghai(C-TEC Shanghai)

Various forms of training can be given
within the facility

Click here for the China page of
our Integrated Report 2023
Medical Business Strategy:
Chinese Market“ Chinese Market
with High Growth Potential”

Chinese Sales Growth Trends in the Medical Business
Revenue in China

Ratio of Revenue in China Accounted for by Medical Business Sales(¥ Billion)

(%)

120

16

90

12

60

8

30

4

0

0

150

FY201320

FY2014FY2015FY2016FY2017FY2018FY2019FY2020

FY2021

FY2022

4.3 times
Comparison between sales
in the Chinese market for
FY2023 and FY2013

FY2023

Efforts in Asian Countries
With a total population of over 1.3 billion people, India is the most promising new market
second to China. From the size of its population and the speed of its economic growth,
it is believed that the availability and use of medical devices in India will advance rapidly inthe future. Similar to Japan and China, there are a number of gastrointestinal diseases inIndia amenable to endoscopic treatment, and endoscopic procedures for biliary andpancreatic diseases are very common. Olympus works with Indian academic societies andsupports endoscopic training sessions. Having established a training center in Thailand in2016 to serve healthcare professionals from Southeast Asia, Olympus is also striving todevelop the medical technology infrastructure in the nations of the region and expand theiruse of endoscopy. Furthermore, Olympus Korea Medical Training & Education Center(K-TEC) was established in 2017. In the future, Olympus intends to continue contributing
to improvements in patient quality of life (QOL) by working to help with endoscopy skill
development and on the wider use of endoscopes for early diagnosis, minimally invasive
treatment, and procedure.

16

Approx.

Olympus Korea Medical Training &Education Center (K-TEC)
Click here for the Asian Countries page of
our Integrated Report 2023 Medical
Business Strategy:
Asian Emerging Markets“Support forTraining of Endoscopists andContribution to Strengthening Medical
Infrastructure in Asian Countries”

3 Craftsmanship for meeting physician needs

NaganoMedical equipment related components

EuropeNorth America
Japan/Asia

Brooklyn Park (U.S.)
Surgical energy devices
Bartlett (U.S.)
ENT devices

AomoriEndotherapy devices,
surgical energy devices
Aizu
Endoscopes,
endoscope reprocessors
ShirakawaVideo system centers (image processors),
light sources, ultrasound endoscopes

Plymouth (UK)
Medical equipment-related components
Cardiff (UK)
Surgical energy devices
Southend-on-Sea (UK)
Endoscope peripherals (trolleys, insufflators, etc.)
Hamburg (Germany)
Rigid endoscopes

HinodeProduction start-up and manufacture of
new element products

Prerov (Czech)
Urology devices
Berlin (Germany)
High-frequency generators

Long Thanh (Vietnam)
Endotherapy devices

The current trilateral approach of Japan/Asia, North America, and Europe is supported by the following manufacturing
centers. In Japan and Asia, we have five domestic plants in Aizu, Shirakawa, Aomori, Hinode (Tokyo), and Nagano, and aplant in Vietnam. All of our mainstay gastrointestinal endoscopes are manufactured in Japan. Surgical devices are
manufactured in North America based at the two manufacturing facilities. The main products are surgical devices for ear,nose and throat and surgical energy devices. In Europe, rigid endoscopes, therapeutic devices for urology/gynecology,
surgical energy devices and endoscope-related equipment are manufactured at six sites in Germany, the Czech Republic
and the UK.

Strength in Advanced Manufacturing Technology
The factories in Japan develop and manufacture gastrointestinal endoscope systems from basic components and have aunique strength in manufacturing that requires a high level of precision and one-of-a-kind assembly expertise on the part ofthe manufacturing staff. Flexible endoscopes are manufactured exclusively at the Aizu factory. For the main components ofthe endoscope, such as the imaging unit, control section, and electrical connector, there are plans to unify development andmanufacturing and to isolate and develop essential key technologies, while realizing high-mix, low-volume production. For
example, Olympus decided to develop the machining equipment necessary to manufacture the stainless steel distal tip of theendoscope in-house, thus keeping this knowledge within the company. Products manufactured by the Shirakawa factory
include video processors and light sources for endoscopes, ultrasound endoscopes, and capsule endoscopes. The strengths
here are component technologies for electrical equipment (including semiconductors and circuit boards), circuit design, andquality assurance. By employing the Kaizen (improvement) activity, quality improves daily and production lead times aredramatically shrinking. The Aomori factory features high-tech production of endotherapy devices. The factory specializes intherapeutic devices such as electrosurgical snares for gastrointestinal polypectomy, devices for use in biliary ducts, etc. The
Hinode factory manufactures disposable products and prototypes. The Vietnam factory, which was established as a satellite
factory of the Aomori facility, produces endotherapy devices and related products.

Characteristics of Endoscopy System Manufacturing
Techniques that Realize High-Mix, Low-Volume Production
The number of different variations of endoscopes we offer
grows each year, and we currently offer more than 300
different models of endoscopes. Creating endoscopes
requires sophisticated manufacturing technologies as wellas high-mix, low-volume production systems. On top of
fulfilling these requirements, we have maintained a stancetoward production that compels us to develop components
and equipment ourselves should the market be unable tosupply us with items that meet our expectations forcraftsmanship. As the components of endoscopes haveincredibly intricate structures, it is impossible to findready-made blades for their production. Therefore, eachtime we need to develop new endoscope components, westart by creating custom blades and other tools capable ofmeeting our design specifications. The unique products
Olympus offers are the result of an ongoing, comprehensive
process of in-house craftsmanship, which entails resolving
issues on our own. This thorough process has enabled us toearn the trust from the world that we hold today.

Detailed eye for customer needs
High-Mix, Low-Volume Production
In-house development of materials, capabilities, and craftedcomponents not otherwise available
High-precision crafting technologies that create components
accurate to the micronJapanese assembly technologies that make fine adjustments
based on combinations of various technologies and expertise

High-precision endoscope tips

Highly precise scope assembly process

17

TSD
Therapeutic Solutions Division
In its Therapeutic Solutions Business, Olympus uses innovative capabilities inmedical technology, therapeutic intervention, and precision manufacturing tohelp healthcare professionals deliver diagnostic, therapeutic, and minimallyinvasive procedures to improve clinical outcomes, reduce overall costs, andenhance the quality of life for patients. Starting with its early contributions to
the development of the polypectomy snare, Olympus Therapeutic Solutions
portfolio has grown to include an array of surgical energy devices and a wide
range of instruments to help prevent, detect, and treat disease.

18

Features of TSD

01

Focus on three therapeutic areas(GI EndoTherapy, Urology, and Respiratory)

In TSD, we contribute to minimally invasive treatment across multiple clinicalspecialties. In particular, we continue to strengthen the product portfolio in the
categories of GI EndoTherapy, Urology, and Respiratory.

02

Globally managed from the U.S.

Strengthen access to key medical clusters and customers in the U.S., the world's
largest therapeutic device market.

03

Enhance capabilities and increase activity in businessdevelopment in an effort to expand the product portfolio
through external partnerships, licensing and M&A

Conducted multiple M&A activities, mainly in the GI EndoTherapy, Urology, andRespiratory.

Market scale and growth forecast of each area

GI EndoTherapy

Urology

Respiratory¥ 350 – 450¥400 – 500¥ 100 – 150

Market CAGR 5 – 7%Market CAGR 5 – 7%Market CAGR 6 – 7%billionbillionbillionNote: S erved market scale and growth forecast information for this page come from the Company’s research and pertains to data for the U.S., EU5 (Germany, UK, Italy, France, Spain),Japan and China, Market scale is as of March 31, 2023, Growth forecasts are projected for fiscal year 2023 to fiscal year 2026. Sub-segment sales ratios within TSD are figures offiscal year 2023.

19

01

Focus on three therapeutic areas(GI EndoTherapy, Urology, and Respiratory)

Focus areas in the TSD
In TSD, we focus on areas where we are highly competitive. In the areas of GI EndoTherapy, Urology, and Respiratory,
we are in a strong position to grow through investments in our product portfolio, educating the market on new,advanced, therapeutic techniques, and leveraging our global sales channels.

GI EndoTherapy

Urology

Respiratory

Market Share

Market Share

Market ShareApprox. 30% of
TSD revenue

Approx. 35% of
TSD revenue

Approx. 15% of
TSD revenue

No. 2

No. 2

No.1

GI EndoTherapy
Category

1 Hemostasis

Hemostasis clip

4 Stenosis release

Stent

Olympus
Right to Win
CAGR FY2024-FY2026:
High single-digit %2 ESD*2 & EMR*3

Resection anddissection device

5 Sampling

Biopsy forceps

3 ERCP*1

ERCP device

6 Device forendoscopy

Colonoscope distal
attachment

Double-digit growth in our ESD/EMR, ENDOCUFF VISION, EndoClot portfolios
Acquisition of broad metal stent portfolio will significantly accelerate our
global position and options in biliary tract, esophagus, colon, andduodenum treatments

Please refer to pages 24-30 for main diseases, procedures, and products in this area.

20

Urology
Category
2

2

1 Benign prostate
hyperplasia(BPH)

2 Urinary stone

Minimally invasive treatment
device for BPH

Thulium fiber laser system

3 Bladder tumor(bladder cancer)

2 3
1

Olympus
Right to Win
CAGR FY2024-FY2026:
High single-digit %ResectoscopeLaunch of single-use ureteroscope will expand clinician options
Portfolio of Laser and Ultrasonic lithotripsy systems enables market share capturePLASMA+ system, one of the growth drivers, continues solid growth xpanded reimbursement for differentiated MIS BPH device which provides
E
better clinical outcomes and elevates the standard of care*4

Please refer to pages 31-32 for main diseases, procedures, and products in this area.

Respiratory
CategoryThoracicTracheobronchial
lymph nodes
tree
Esophagus

1 EBUS-TBNA(Endobronchial ultrasoundtransbronchial needle
aspiration)

EBUS-TBNA system
Lung

2 Diagnostic andtherapeutic
bronchoscopy

Intrabronchial valve system

Peripheral pulmonary
lesionOlympus
Right to Win
CAGR FY2024-FY2026:
Mid single-digit % ifferentiated solutions such as EVIS X1 bronchoscopes and EU-ME3
D
endoscopic ultrasound processor expected to drive robust future growth ommitted to delivering meaningful innovation to optimize patient outcomesCin bronchoscopy and lung cancer staging & diagnosis procedures

Please refer to pages 32-33 for main diseases, procedures, and products in this area.

*1 Endoscopic Retrograde Cholangio Pancreatography*2 Endoscopic Submucosal Dissection*3 Endoscopic Mucosal Resection*4	iTind procedure does not require a permanent implant and preserves sexual function and continence, while reducing the need for a post procedure catheter. Procedure can be done in the MD
office setting.

21

02

Globally managed from the U.S.

Olympus' global headquarters for the TSD is located in the U.S., which is
the world's largest market for therapeutic devices and the highest-sellingmarket in our business.
We also make global decisions in the U.S. because we have accessto a large number of hospitals, research institutions, competitors, andcustomers.
U.S.-based global
headquarters for the TSD

03

Enhance capabilities and increase acitivity inbusiness development in an effort to expand the
product portfolio through external partnerships,
licensing, and M&A

The establishment of a global headquarters in the U.S. has enabled us to efficiently and quickly expand andcomplement our product portfolio through collaboration with external partners, licensing, and M&A. In August
2020, we acquired Arc Medical Design Ltd., a UK medical device manufacturer, and in May 2021, Medi-Tate
Ltd., an Israeli medical device company. We are expanding our portfolio respectively. In order to contribute tominimally invasive treatments, we will continue to accelerate our growth not only through in-housedevelopment but also by considering external partnership and distribution agreement.

M&A
In August 2020, Olympus acquired Arc Medical Design Ltd., a UK medical device manufacturer, toexpand its portfolio of GI EndoTherapy.

Arc Medical Design

Representative product: ENDOCUFF VISION
A device that attaches to the distal end of a colonoscope, designed to help maintain visibility duringcolonoscopy and endoscopic polypectomy by allowing the flexible arm to scrape the folds of thecolon and fix the mucosa.

In May 2021, Olympus acquired Medi-Tate Ltd., an Israeli medical device company, to expand its
urology portfolio.

Medi-Tate

22

Representative product: iTind
A minimally invasive treatment device for the treatment of BPH. It allows for day treatment in medical
offices and clinics, no permanent implants for the patient, and a wide range of re-treatment options.

TOPIC

Single-use Endoscope

Approach to Reusable and Single-use Endoscopy
One of strategic value pools in our company strategy
unveiled in May 2023 is business and global expansion.
We continue to recognize the market opportunity forsingle-use endoscopes and complement our reusable
endoscopy product portfolio with single-use endoscopes.
Reusable endoscopes will continue to be the first choice
for a wide range of procedures due to the strong clinicalneed for advanced imaging and maneuverability as wellas their financial efficiency for hospitals. At the sametime, as single-use endoscopy is quickly becoming a
relevant option for selected procedures, the market for
single-use endoscopes is expected to grow by 15–18%*
annually from 2020 to 2030.
As a global leader in endoscopy, we are developing
single-use endoscopes on the strength of our expertisein visualization, maneuverability and ergonomics, as wellas our largest installed base in the market.
*Growth forecast information comes from the Company’s research.

Areas in which We Plan to Develop (or Launched) Single-use Endoscopes (As of October 2023)

We have established a strategic approach to single-use endoscopy that is aligned with
our goal to be the Endoscopy Partner of Choice, with best-in-class solutions providing
the right scope for every patient, procedure and site of care.
Pioneers in visualization and maneuverability
Best-in-Class
Visualization

Infection
ControlHigh
Maneuverability

Largest installed base in the market
Improves Workflow(on-demand solution)

Durable &ReliableManaging
Costs

Focus on innovative visualization technology to provide clinicians withthe optimal range of endoscopes to meet their needs:
GI

Urology

Respiratory

Duodenoscopes/
Cholangioscopes:

Ureteroscopes:

Bronchoscopes:

Planned launch
FY2025

Launched FY2022

Planned launch
FY2025–FY2026

Rhinolaryngoscopes:
Launched FY2024

Spotlight: Product Launch in the U.S.

E-SteriScope Single-use Flexible
Video Rhinolaryngoscope
Launched in 2023, the E-SteriScope
portfolio delivers options for both
diagnostic and therapeutic procedures
complimenting Olympus’ existing video
platform to provide a comprehensive ENT
solution.
The E-SteriScope is a collaboration with Hunan Vathin
Medical Instrument Co., Ltd. Olympus does not handle
E-SteriScope in Japan.

Single-use scopes help avoid procedural delays stemming from scope availability:
For off-hours when reusable options are not available
For physicians who need to quickly scope a patient at bedside

Note: Products or devices presented include future technology which may be pending regional regulatory approval and are not available for sale in all regions.

23

Appendix

Main Diseases, Procedures, and Products
GI: Digestive Tract (Esophagus/Stomach/Large Intestine/Small Intestine)
Main diseases 1

Esophageal Cancer

The walls of the esophagus are made from multiple layers of mucosa and muscle.
Cancer of the esophagus typically occurs in the innermost mucosa. This is called“ squamous cell carcinoma ”and over 90% of Japanese people with cancer of theesophagus have this type of cancer. Habitual drinking and smoking are sources ofrisk. There is another type of esophageal cancer called“ adenocarcinoma ”which
is more common in Europe and the U.S. This type of cancer is found in 60-70%
of esophageal cancer cases in Europe and the U.S. The primary cause of
adenocarcinoma is a condition called Barrett's esophagus, where stomach acidflows up the esophagus and causes inflammation of the esophageal mucosa.

Main diseases 2

Stomach Cancer

It is thought to arise in the mucosas of the stomach from gastritis and atrophy.
When atrophy occurs in the mucosas of the stomach, it leads to atrophic gastritis,which can lead to“ intestinal metaplasia, ”a condition in which the stomach-type
mucosa turns into intestinal-type mucosa. Intestinal metaplasia is known todevelop into cancer. Recently it has been shown that this is related to thebacterium Helicobacter pylori. H. pylori causes inflammation of the mucosa in thestomach and has been observed to lead to atrophic gastritis and intestinal
metaplasia.

Esophagus

Orifice ofthe stomach
Lessercurvatureof thePylorus stomach

Greatercurvatureof thestomachStomachMain diseases 3

Large Intestine Cancer

It is increasing in Japanese people as they are starting to eat a more Western
diet. Cancer of the large intestine includes both colon cancer and rectal cancer,
but colon cancer especially is increasing rapidly. Consuming animal fats causes
greater secretion of biliary acid to help with digestion. There are carcinogens
among the substances that develop when digesting fats. It is believed that cancer
occurs in the mucosa of the large intestine.
The inside of the large intestine consists of four layers. Sometimes, benign
polyps called adenomas occur in the mucosa. Many cases of colorectal cancer
are believed to be related to these polyps. Furthermore, it has been recently
discovered that there are also flat and depressed cancers that develop directlyfrom the mucosa. The most common areas for colorectal cancer are the rectumand sigmoid colon, which cancers account for about 70% of all cases.

Ascending colon

Transverse colon

Descendingcolon

Sigmoidcolon
RectumLarge intestine

Main diseases 4

Colon PolypA tissue that protrudes from the mucous membrane of the colon is called a colon
polyp. The polyp has a high probability of occurring in the rectum or the sigmoid
colon, and its size is between a few millimeters and 3cm. They are largely divided
into neoplastic and non-neoplastic polyps. Small polyps are generally
asymptomatic, but if they become large, symptoms such as fecal occult bloodand fresh blood in the stool can occur.

Main diseases 5

Small Intestinal Ulcer

An ulcer that appears in the small intestine. Frequency of occurrence is not high,with less than a 5% chance overall of becoming a gastrointestinal tumor, however,malignancy is high since two-thirds of all small intestinal ulcers are malignant
tumors. These ulcers are mainly discovered when examining such symptoms as
pain, bleeding, or stricture of the abdomen. Although early diagnosis is difficult,through the improvement of endoscope technology, such as capsule endoscopes
and balloon endoscopes, which enable detailed examination of the small intestine,
small intestinal tumors are being discovered with greater frequency.
24

Small intestine
Duodenum Jejunum and ileum

Small intestine and surrounding organs

Appendix

Main diseases 1 2Main scopes used in ESD

Gastrointestinal Scope

Gastrointestinal videoscopes are for viewing the stomach and duodenum
through the esophagus and usually have an insertion tube length of
1,030mm. Videoscopes have a forward-facing lens on the distal tip which
is ideal for observing tissue directly in front of the endoscope. Videoscopes
designed to be inserted through the mouth typically have an insertion tube
diameter of around 10mm; videoscopes designed for passage through thenose are about half that diameter.

Main diseases 3 4Main scopes used in ESD

Colonoscope

Colonovideoscopes are longer than gastrointestinal videoscopes in orderto accommodate the long 1.5m length of the adult large intestine.
Standard-length colonovideoscopes are 1,330mm long. Extended length
models are 1,680mm long. The colonovideoscope has a forward-facing
tip. In order to facilitate insertability into the colon a flexibility adjustmentring allows the operator to adjust the stiffness of the insertion section
during the procedure. Colonovideoscopes typically have an insertion tube
diameter of around 13mm.

Main diseases 5
Main scopes used in ESD

Gastrointestinal
videoscope

Colonovideoscope

Small Intestinal Scope

This involves using an endoscope with a balloon attached on the distal
end such that the inflated balloon holds the intestine open and allows theendoscope to be moved forward. Insertion can be via either the mouth oranus. As the instrument channel outlet is also provided, as on aconventional endoscope, it can be used for biopsies or to perform simple
procedures. To be long enough to view the small intestine, the endoscope
has a length of 2,000mm and a diameter of approximately 9mm.

Small intestinal
videoscopeSingle balloon
enteroscope

Ultrasoundgastrovideoscope

Ultrasound image

Ultrasound Gastrovideoscope
In addition to regular endoscopes, Olympus manufactures“ ultrasoundvideoscopes ”that allow combined endoscopic imaging and ultrasoundimaging of the organ under inspection. They have an ultrasound transducer
installed on their tip. By using medical ultrasound technology, lesions thatcannot be seen from the surface and are located deep in the organ can befound. In the digestive tract, this kind of endoscope is used to find tumorsand cancers hidden below the surface of the GI tract and to examine
varices in the esophagus. They are also used to find cancer, gallstones
and pancreatic stones in the pancreas and biliary tract. Biopsy needles
inserted under ultrasound guidance can diagnose hidden submucosal
tumors and diagnose and treat pancreatic cysts.

25Appendix

ENDO-AID, an Endoscopy CAD*1 Platform Equippedwith an AI-powered Diagnostic Support Application
for Colonoscopies
When used in combination with the EVIS X1 gastrointestinal endoscopy
system, ENDO-AID serves as a CAD platform that can automatically detectand display possible lesions such as polyps and cancer in real time. By
adding AI-powered support, ENDO-AID makes colonoscopies easier forboth physician and patient and aims to improve overall clinical results
regardless of the doctor's experience. Equipped with ENDO-AID CADe* 2,
a detection support application for lesions in the large intestine.
ENDO-AID

ENDOCUFF VISION, Colonoscope Distal Attachment
This device is attached to the colonoscope ’s distal end to support
visualization in procedures such as colonoscopy screening and polypremoval. ENDOCUFF VISION features a proprietary design comprised of aflexible arm with extensions placed on the device circumference. The arms
open the colon ’s bended section and mucosal folds, providing a clearerview inside the colon and making it easier to detect polyps and adenomas.
Research* 3 shows that compared with standard colonoscopies, those
performed using this technology increase the adenoma detection rate(ADR) by up to 11%. According to this research, each 1% improvement in
the ADR lowers the risk of colon cancer by 3%.

ENDOCUFF VISION*1 Computer Aided Detection/Diagnosis: AI-powered diagnostic and detection support*2 Computer Aided Detection: AI-powered detection support*3	Williet, N., Tournier, Q., et al. Effect of Endocuff-assisted colonoscopy on adenoma detection rate: meat-analysis of randomized controlled trials. Endoscopy, 50 (9), 846-860. Doi:10.1055/
a0577-3500. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29698990

Diagnostic method
regarding main diseases 1 2 3 4 5

BiopsyA biopsy is a diagnostic procedure that removes pieces of tissue which issuspected of being a lesion, subject to pathological testing under a microscope.

Main endotherapy devices used in TSD

Biopsy Forceps

Biopsy forceps include the standard type and also a type with a needle which
prevents slipping on the surface of mucosa. Various biopsy forceps are used suchas a single-side opening type for the esophagus and the wide-opening type used
for stiff mucosa.

Diagnostic method
regarding main diseases 1 2 3 4 5

BiopsyBiopsy forceps withneedleSpraying Lugol into
the esophagus(image)Spraying tube

Dye Spraying

In order to identify tumors or other lesions in the early stages, dye, such as
Indigo carmine solution and Lugol iodine solution, is sprayed on the surface ofthe mucosa. This procedure enables easier observation of mucosal surface
shape change.
Main endotherapy devices used in TSD

Spraying Tube

An endotherapy device for spraying dye on an observation site.

26

Appendix

Method of treatment in internal medicine

regarding main diseases 4

Polypectomy

A polypectomy is a procedure that removes local elevated lesions called polyps
which grow out of the mucous epithelium. A wire snare is looped around the baseof the polyp, and a high-frequency electrical current is applied while the snare istightened. The polyp is then burned off and collected using gripping forceps.
There is also a method called“ cold polypectomy, ”in which polyps of less than
10mm are squeezed and removed without applying high-frequency current.
Main endotherapy devices used in TSD

Electrosurgical Snare

Polypectomy

Electrosurgical snare

Hot biopsy

Hot biopsy forceps

EMRC method

Clear cap

An electrosurgical snare is forceps made of looped metal wire. The therapeutic
device applies a high-frequency current to ligate the lesion site and then burn off
the lesion. Among high-frequency snares are ones that can carry out a cold
polypectomy that severs the lesion without applying a high-frequency current.

Method of treatment in internal medicine

regarding main diseases 4

Hot Biopsy

For small polyps and relatively flat (sessile) polyps, a procedure called a biopsy
can be performed. While pinching the polyp with a biopsy forceps, high-frequency
current is used to remove the tissue and cauterize the polyp base, preventing
bleeding from the site.
Main endotherapy devices used in TSD

Hot Biopsy Forceps

Hot biopsy forceps can collect tissue while applying a high-frequency current to acup unit. The end section is about the same structure as a biopsy forceps. The
operating section has a plug for connecting to an electrosurgical generator.

Method of treatment in internal medicine

regarding main diseases 1 2 3 4Endoscopic Mucosal
Resection (EMR)

EMR enables the removal of small flat lesions such as early-stage cancers. There
are several techniques for performing EMR. One of these is so-called“ cap EMR ”(EMRC). This procedure uses a transparent plastic cap fitted over the tip of theendoscope. The lesion is first raised by injecting normal saline into the submucosa
under the lesion. The raised tissue is then sucked into the cap attached to the tipof the endoscope and is cut off using an electrosurgical snare positioned inside
the cap. The lesion is then recovered using suction.
Main endotherapy devices used in TSD

Clear Cap

Equipped with a scope end-section, clear cap is used to remove a lesion bysuction.

27

Appendix

Method of treatment in internal medicine

regarding main diseases 1 2 3Endoscopic Submucosal
Dissection (ESD)EMR is limited to removing lesions smaller than 2cm. ESD was developed as a procedure
for removing much larger (and more irregularly shaped) lesions. First, an electrosurgicalelectrode is used to make small burn marks to outline the area around the lesion. The
lesion is then raised by injecting normal saline into the submucosa to separate the lesion
from the normal tissue below. Next, the mucosa around the lesion is cut using anelectrosurgical knife. The submucosa is then separated, and the lesion is recovered using
forceps.
Main endotherapy devices used in TSD

ESDElectrosurgical knife

Electrosurgical Knife

A therapeutic device for removing larger early-stage lesions. There are knives with a ceramic insulator attached to the tip of the needle
knife. The insulator lowers the risk of perforation in the digestive tract and also enables large-scale mucosa removal.

Method of treatment in internal medicine

regarding main diseases 1 2 3 4 5

Hemostasis

A hemostasis procedure is sometimes required to control the bleeding that results fromremoving polyps and other lesions. There are several ways to stop bleeding using an
endoscope.
Main endotherapy devices used in TSD

Clip

The clip acts to pinch the open blood vessel closed, and applies pressure to the tissue tostop the bleeding. In the clip hemostasis method, the clip tip is left in place after
compression.
Main endotherapy devices used in TSD

Clip hemostasis

High-frequency
hemostatic forceps

High-Frequency Hemostatic Forceps

Hemostatic forceps that use high-frequency securely grip large blood vessels or hard and slippery tissue, enabling coagulation to occur.

Method of surgical treatment

regarding main diseases 2

Laparoscopy-Assisted Distal
Gastrectomy (LADG)

This surgery is limited in application to early-stage cancers from the lower part of thestomach (pyloric antrum) to the middle of the stomach (body of the stomach). The
standard procedure is to remove at least two-thirds of the stomach and the lymph nodes
around the stomach. The reason this is called a“laparoscopy-assisted”procedure is thatthe surgery requires a laparotomy, albeit with a smaller incision.
The two basic methods for reconstructing the stomach are the Billroth I method andthe Roux-en-Y method. In the Billroth I method, the remaining stomach and theduodenum are joined. In the Roux-en-Y method, the remaining stomach and the jejunum
are joined, and the remaining duodenum is connected to the bottom of the jejunum. Foodflows from the stomach to the jejunum, where it mixes with digestive fluids that flow infrom the duodenum.
If these surgeries are not appropriate for the patient, there is still another kind of
stomach cancer surgery called Laparoscopy-Assisted Total Gastrectomy (LATG).

Method of surgical treatment

regarding main diseases 3

Roux-en-Y method

Laparoscopy-Assisted
Colectomy

Colorectal cancer surgeries target the large intestine, cecum, and rectum. As withstomach cancer, the goal of these surgeries is to remove the affected area as well as theassociated lymph nodes. Compared to the stomach, the structure of arteries and veins
supplying the colon is simple and the removal of associated lymph nodes is easy.
Therefore, it is said that there is a high chance that laparoscopy-assisted colectomy may
become the standard surgery for colorectal cancer in the near future.

28

Billroth I method

Laparoscopy-assisted colectomy
Note: The above image of the procedure is from the casereport by Dr. Arita of Kyoto Prefectural University of
Medicine.

Appendix

Main therapeutic devices used in TSD

Surgical Systems

Systems used in surgery are described on
pages 36-37.

GI: Biliary Tract / Pancreas
Main diseases 1

Gallstones

Liver

Hepatic duct

A medical condition in which a stone can appear in the biliary tract (generic term
for the bile duct, gallbladder, and major duodenal papilla). Gallstones that form in
the gallbladder are particularly common. Biliary tract cancers, which can appear
in the gallbladder and bile duct, are understood to be connected to gallstones. Ifgallstones injure the biliary tract, they can cause inflammation, which can turn into
cancer if prolonged.

Main diseases 2

Pancreatic Cancer

It comes from pancreatic cells. Pancreatic cancer is divided into two types:
exocrine (digestive enzyme secretion system) and endocrine (hormone secretion
system). About 95% of pancreatic cancer is of the exocrine type, and about 85%of these are invasive pancreatic duct cancers that occur on the epithelium of thepancreatic duct. Pancreatic cancer typically occurs in individuals who are 50–70
years old, especially in elderly males.

Main diseases 1 2Main scopes used in ESD

Bile duct

Gallbladder

Major duodenal
papillaPancreas

Duodenoscope

Unlike gastrointestinal videoscopes and colonovideoscopes,
duodenovideoscopes have a side-viewing tip design in which the lens andillumination optics are on the side of the scope. This enables the scope toperform procedures such as Endoscopic Retrograde Cholangio
Pancreatography (ERCP) that is imaging of the pancreaticobiliary ducts via
the duodenum, and for performing Endoscopic Sphincterotomy whichallows removal of gallstones via the mouth. This endoscope has a prism at
its tip to allow it to look perpendicular to its axis, and a forceps elevator todeflect accessory devices in the same direction. Duodenovideoscopes
typically are 1,240mm long.

Duodenovideoscope

Side-viewing tip
design(including forceps
elevator system)

Note: A single-use scope is planned for future release.

Main diseases 1 2Main scopes used in ESD

Cholangioscope

Cholangiovideoscope is a miniature scope inserted in the instrument
channel of a duodenovideoscope. It can be used for direct observation
inside the narrow duct of the pancreaticobiliary system or to collect tissue.
Note: A single-use scope is planned for future release.

Diagnostic method
regarding main diseases 1 2

Cholangiovideoscope

Endoscopic Retrograde Cholangio
Pancreatography (ERCP)

ERCP is method for examining the biliary tract and pancreatic duct using a
combination of endoscopic and radiographic techniques. Using an endoscope,a thin tube (cannula) is inserted through the papilla of Vater into a duct of thepancreaticobiliary system. Radiological contrast dye is then injected into theducts, and the area is viewed using X-rays.

Main endotherapy devices used in TSD

CannulaA thin tube for injecting radiological contrast dye into the pancreatic or bile ductthat can then be viewed by X-rays.

ERCP

Cannula29

Appendix
Method of treatment in internal medicine

regarding main diseases 1

Endoscopic
Sphincterotomy

It is a procedure that is often used to remove gallstones. A papillotomy knife(papillotome) is inserted into the opening of the duodenal papilla, and the papillarysphincter is cut open. Following this, a stone extraction balloon or stone retrieval
basket can be inserted into the biliary ducts to remove any gallstones residing in
the biliary system.
Main endotherapy devices used in TSD

Papillotome

An electrosurgical knife inserted into the papilla at the end of the bile duct for use
in incision using high frequencies.
Main endotherapy devices used in TSD

Endoscopic
Sphincterotomy

Papillotome

Stone extraction
balloonStone retrieval basket

EBD

Plastic stent

Detachment ofgallbladder

Removal throughincision

Stone Extraction
BalloonA balloon-shaped catheter used to scrape out small stones resembling sandand silt.
Main endotherapy devices used in TSD

Stone Retrieval Basket

An endotherapy device that is used to help retrieve and remove stone fragmentsfrom the bile duct.

Method of treatment in internal medicine

regarding main diseases 1

Endoscopic Biliary
Drainage (EBD)

If the free flow of bile to the duodenum is hindered due to gallstones or a stricture(narrowing) of the bile duct due to disease, EBD may be performed by inserting aplastic or metal stent into the duct to allow the free flow of bile.
Main endotherapy devices used in TSD

Plastic Stent

When a bile duct has a stricture or blockage, this stent is inserted into the duct
and releases bile. The device is implanted for a short period of time (aroundseveral weeks).
Main endotherapy devices used in TSD

Metal Stent

This stent is made of metal mesh. The post-implantation lumen is larger than for aplastic stent and can be expected to have large drainage. Comparatively
long-term (several months) patency and detainment is possible.

Method of surgical treatment

regarding main diseases 1

Laparoscopic
Cholecystectomy

This is the most common type of endoscopic surgery in Japan. The gallbladder is
attached to the underside of the liver, and must be carefully removed using anelectrosurgical knife and dissecting forceps. Next, the cystic artery and cystic
duct are clamped with clips and cut to separate them from the liver. Finally, a
trocar is inserted and the gallbladder removed from the body through the trocar
using grasping forceps.
Main therapeutic devices used in TSD

Surgical Systems
Systems used in surgery are described on
pages 36-37.

30

Appendix

Urology
Main diseases 1

Benign Prostate Hyperplasia
(BPH)

Male

A condition in which urination is obstructed by pressure placed on the urethra by
an enlarged prostate, which is located under the bladder. Symptoms include a
sensation of residual urine and more frequent trips to the toilet due to the reduced
amount of urine passed at each urination.

Main diseases 2

KidneyUrinary Stone

A condition in which substances contained in urine crystalize for some reason andcoalesce in the form of a stone. Typical symptoms include extreme pain, bloody
urine, or the presence of the stone in urine.

Main diseases 3

Adrenalgland

Bladder Tumor(Bladder Cancer)

This occurs when the urothelium becomes cancerous. While most cases (90% ormore) are categorized as urothelial cancer, rare instances of squamous cell
carcinoma and adenocarcinoma also occur. The main symptoms are bloody urine
or pain during urination.

Main diseases 1 2 3Main scopes used in TSD

RenalpelvisUreterBladder

Seminalgland

UrethraProstate
Testicle
Urinary system

Ureteroscope / Cystoscope

They are used for viewing the urinary bladder through the urethra and thekidneys through the urinary duct. Olympus manufactures bothvideoscopes and fiberscopes for this application. The videoscope version
supports high-definition imaging due to its high performance CCD and isalso capable of NBI. Moreover, in order to facilitate the observation of the
bladder neck, both the Up and Down sides bending angle of 275 degrees
are realized.

Ureteroscope

Note: A single-use scope (ureteroscope) is planned for future release.

Main diseases 1 3Main scopes used in TSD

Resectoscope

A resectoscope is a rigid endoscope for diagnosing and treating theurethra and bladder. It is inserted in from the external urethral orifice andused for the surgical resection of a lesion with high-frequency current.

Method of treatment

regarding main diseases 1 3

Resectoscope

Transurethral Resection(TUR)

TUR is a procedure in which a surgeon inserts a resectoscope from the urethra
and then, using the handle, operates a loop-shaped electrode to surgically resect
tissue from an enlarged prostate or a bladder tumor with an electrosurgical knife.
For a safe procedure and precise resection, the solution from Olympus is the
TURis procedure, in which a resection is performed by discharging electricity fromthe entire area surrounding the electrode through saline.
Main therapeutic devices used in TSD

Flexible bending
function

Resection of the enlarged prostate when aresectoscope is inserted transurethrally
near the neck of the urinary bladderElectrosurgical
Generator

The equipment enables incision of a lesion and coagulation by connecting to an
endotherapy device and generating a high-frequency current.

Electrosurgical
Generator

Resectoscope andspecial-use electrode31

Appendix

Method of treatment

regarding main diseases 1

Treatment throughNon-Ablative Device

Olympus is rolling out iTind, a minimally invasive treatment device that ensures urine flowby expanding the urethra over the span of five days after longitudinally implanting athree-wire nitinol device in the prostate. iTind enables a patient to be treated at a doctor’soffice or clinic, returning home the same day, and to achieve resolution of symptoms
without a permanent implant left behind.
Method of treatment

regarding main diseases 2

Transurethral
Lithotripsy (TUL)

During Lithotripsy, an urologist navigates an endoscope through the urinary tract and uses
laser or ultrasonic energy to break up one or more stones in the bladder, ureter, or kidney.
The resulting stone fragments may be expelled naturally or can be removed using stone
retrieval baskets.
Main therapeutic devices used in TSD

Minimally invasive
treatment device for BPH

Image of removing stones with stone
retrieval baskets

Thulium Fiber Laser
SystemThis product uses superpulsed thulium fiber laser technology for the removal of stones in
the urinary tract (the kidney, ureter, bladder, and urethra) and for resection of soft tissue. It
works by breaking up the stone into tiny pieces which are then passed out of the bodyduring urination. The device helps shorten operation time by improving performance forbreaking the stones. The device is also used to treat soft tissue (such as the prostate),enabling Olympus to provide urologists with a variety of procedural solutions. The
compact size of the equipment helps to save space and make movement easier between
operating rooms.

Thulium fiber laser system

Respiratory
Main diseases 1

Lung Cancer

Lung cancer consists of malignant tumors of the bronchial tubes and pulmonary
epithelium. Instances are on the rise due to smoking and other causes. Among cancers, it
has the highest mortality rate worldwide.*

Trachea
Right lungLeft lung*WHO cancer statistics: http://www.who.int/news-room/fact-sheets/detail/cancer

Main diseases 2

Emphysema

A condition caused by the over-inflation of the alveoli located at the tips of the bronchi
leading to the destruction of lung functions. It is defined as one of the forms of chronic
obstructive pulmonary disease (COPD) in which inhalation of tobacco or other harmful
substances causes inflammation of the lungs and bronchus, which in turn causes
progressive breathing difficulties.

Main diseases 1 2Main scopes used in TSD

Lungs

Bronchoscope

Olympus manufactures three types of bronchoscopes for viewing the lungs andbronchial tubes: videoscopes, fiberscopes, and a“hybridscope”which has both
fiber-optic and video components. Bronchoscopes may be inserted either through themouth or the nose and can travel down to examine the smallest lumens of thebronchial tree. Videoscopes have an advantage in obtaining sharp pictures of the lungthrough their high quality CCDs. Fiberscopes have an advantage in being smaller indiameter at the tip and therefore allow for deeper insertion into the distal portion of
bronchial tubes. The hybrid type has a fiber-optic bundle in its tip and a CCD image
sensor installed in its control section. This instrument incorporates advantages of bothvideoscope and fiberscope technology, with high insertability due to its small diameter
while at the same time also producing high-quality images.
Note: In April 2021, sales started in the U.S. for Olympus’ first single-use bronchoscope.

32

Bronchus

Bronchoscope

Appendix

Diagnostic method
regarding main diseases 1

EBUS-TBNA(Endobronchial ultrasound transbronchial needle aspiration)

A technique mainly for the purpose of diagnosing lymph node metastasis in lungcancer. The procedure uses ultrasonic images in real time to guide the insertion of aneedle into the lymph node via the trachea and bronchus for the collection by
aspiration of cell or tissue samples. The collected samples are observed anddiagnosed in detail by pathological examinations before deciding on the next courseof treatment.
Main endotherapy devices used in TSD

Aspiration Needle

This endotherapy device is guided by a ultrasound endoscope and is used for thecollection by aspiration of cell or tissue samples from the trachea and bronchus.

Diagnostic method
regarding main diseases 1

EBUS-TBNA system

EBUS bronchoscope
and aspiration needle

Cytology of bronchus

Cytology brushIntrabronchial valve
systemEndobronchial valve

Cytology

Cytology is performed by scrubbing a brush over a mucosa and observing thecollected cells under a microscope.
Main endotherapy devices used in TSD

Cytology Brush

A brush for collecting cells from the bronchial tubes with narrow openings. The cytology
brushes are 1-5mm in diameter and less than 10mm in length.

Method of treatment

regarding main diseases 2

Bronchoscopic Lung
Volume Reduction

A minimally invasive procedure for emphysema. The procedure reduces lung volume by
deploying a valve within the bronchial tube to close off the lung cells. Specifically, a small,umbrella-shaped valve is implanted in the lung’s upper lobe bronchus via a catheter
inserted into the instrument channel of a bronchoscope. The purpose is to redirect the
airflow from the unhealthy part of the lung to a normal section through the effects of aone-way valve used as the implanted valve.
Main endotherapy devices used in TSD

Endobronchial Valve

This valve is a therapeutic device for emphysema. It is used when medicines have noeffect or in which neither a lung reduction procedure nor transplant surgery is notapplicable. It is also used to treat postoperative prolonged air leaks arising from apneumothorax or lung surgery.

Method of treatment

regarding main diseases 1

Pulmonary Resection

Lung cancers are now being surgically resected using endoscopes.
Thoracoscopic partial lung resection surgery can be performed for removing
tumors smaller than 3cm in diameter, and lung lobectomies performed for treatingareas greater than 4cm in breadth.
Main therapeutic devices used in TSD

Surgical Systems
Systems used in surgery are described on
pages 36-37.

Pulmonary Resection (image)33

Appendix

Ear, Nose, and Throat (ENT)
Main diseases 1

Tympanitis

A condition in which the infection of the middle ear by bacteria, viruses, or othergerms due to a cold, etc., causing inflammation and a buildup of pus or fluid.
Symptoms include headache, dizziness hearing difficulties, or the ear feelingblocked.

Main diseases 2

Ear canal
Middle ear

Eustachian
tube

Ear
Paranasal sinuses

Sinusitis

What is commonly known as empyema is a condition resulting from inflammationof the paranasal sinus due to causes such as a common cold, hay fever, or dental
decay. It results in a blocked nose with thick colored mucus. Other symptoms
include headache and an impaired sense of smell.

Main diseases 3

Eardrum

Nasal cavity
Oral cavity

Laryngeal/Pharyngeal Cancer

A throat cancer common among males. The symptoms, which include a sorethroat and loss of voice, are similar to the common cold.

TonguePharynx

LarynxGlottisNose / Throat

Main diseases 1 2 3Main scopes used in TSD

Rhino-Laryngo Scope

Rhino-Laryngo videoscopes are used for looking at the ears, nose, andthroat. Latest videoscopes mount ultra compact, high-performance CCD,
and realize great advances in image quality compared with conventionalmodels. They are also able to perform NBI.

Method of treatment

regarding main diseases 2

Endoscopic Sinus
Surgery (ESS)A minimally invasive treatment for treating sinusitis (empyema) in which chronic
inflammation of the paranasal sinuses (cavities enclosed in bone located near thenasal cavity) causes them to fill with pus and contaminated mucosas. Endoscopic
sinus surgery uses an endoscope to provide a view inside the nose while using adebrider to perform treatment.
Main therapeutic devices used in TSD

Rhino-Laryngo
videoscope

DebriderEndoscope

DebriderESS (image)

A debrider is a surgical device for removing abnormal tissue with simultaneoususe of suction and cutting.

Debrider34Appendix

Structure and Components of Endoscopes
Outline of Gastrointestinal Endoscopy System

1

Current gastrointestinal endoscopes for examining the esophagus, stomach,and large and small intestines are mostly videoscopes. Videoscopes have anelectronic image sensor attached to the distal tip of the instrument. A
videoscope system consists of the following equipments.

1

LCD monitor

2
Video
scope

Main body : LCD monitor
Video system center

Endoscope1

The video system center converts the electrical signals from an image sensor
at the tip of a videoscope into video signals and displays them on an LCD
monitor.
In addition to high-definition vision, the system supports various types ofimage processing including color enhancement and Narrow Band Imaging(NBI). The latest units are integrated with a light source and come equippedwith an LED with a long life span. To improve color reproductivity, the system
has adopted five-color LEDs supporting violet, blue, green, amber, and red. It
also has an automatic dimming feature (automatically adjusts the brightness)
and a pump that transmits water and air.

2

Main
body

Video systemcenter with abuilt-in lightsourceMain
body

Endoscope

The endoscope has three parts: the control section, the insertion section, and the connector section.
● Control Section

The angulation knob on the control section is connected to the tip of theendoscope by a series of wires. By turning the angulation knob, the bending
section at the distal end bends horizontally and vertically allowing for easierinsertion into the body and the ability to view 360 degrees within body
cavities.
The endoscope also contains buttons (valves) for feeding air or waterand for applying suction. Covering the opening in the air/water valve will feed
air into the organ being observed and will gently expand it for a better view.
Depressing this valve will feed water through the endoscope to wash theviewing lens. Depressing the suction valve will allow the doctor to use theendoscope to suction any fluids which are obscuring a good view of thetissue. Endotherapy devices can be passed through the instrument channel
for performing endoscopic biopsy and other treatments.
● Insertion Section

On the tip of the insertion section, there are four main parts: 1. Objective lensand image sensor, 2. Light guides that bring light from the light source throughthe endoscope, 3. Instrument channel outlet where endotherapy devices canbe pushed in and out (also has a suction opening), 4. Nozzle for feeding waterand air.
The objective lens is typically a super-wide-angle lens in order tovisualize a large area of tissue at one time. In order to view tumor tissue in amore detailed manner, some endoscopes have an optical zoom feature. They
also support high-definition video displays.
Light guide fiber bundles conduct light from the external light source
through the endoscope to illuminate body cavities. Endotherapy devices arepushed in and out of the instrument channel for harvesting tissue (biopsy),
removing tumors, cauterizing bleeding lesions, etc. The nozzle on the distal tip
is used to clean the lens with water and expand body cavities by insufflatingthem with air.

Control Section

Suction button

Air/water button

Universal cord
Angulation control knob
Grip section
Instrument channel

Insertion
SectionDistal End

Insertion section
Insertion
tube

Distal end
Bending
sectionInstrument
Objective lenschanneloutletAir/water nozzle(can clean lens surface)

Light guide

Connector Section
SectionSuction port
port
Suction

Ventilation port
port
Ventilation

Electrical contact
contact
Light guide
guide● Connector Section

The connector section connects the endoscope with the video system center through the universal cord. Supply of air andwater is also performed through this connection.

3●

Peripheral

Imaging Management Hub

Imaging management hub simplifies the process of recording, managing, andediting high-resolution endoscopic images (video and still images).

Imaging management hub

35Appendix

Outline of Surgical Endoscopy System
The following instruments are used in endoscopic surgery. As open surgery is
gradually being replaced by endoscopic surgery, the sophistication ofendosurgical device has increased.

1
LCD monitor

Main body3

1

Insufflator

Main body : LCD monitor
Video system center
Xenon light source for IR imaging

Peripheral

1
Video systemcenter with abuilt-in lightsourceSurgical endoscopy systems include models that are compatible with 3D
endoscopes, which make it easier to grasp depth, and models equipped with 4K
monitors, which provide clear, high-definition images with greater detail. The video
system center with a built-in light source serves as a processor that converts theelectrical signals from the videoscope into video signals to display on an LCD
monitor and functions as a light source that supplies light to the scope tip via thelight guide cable. Some xenon light source devices enable infra-red (IR)observation.

Main body

Xenon lightsource for IR
imaging2
Videoscope/
Rigid
endoscope(Telescope)

Endoscope

3
Imaging management hub

2●

Peripheral

EndoscopeVideoscope

In general, videoscopes have a diameter of 5-10mm and a length of 300-370mm.
Their tips contain a lens, a CCD image sensor, and light guide fiber bundles forbringing illumination into the body. Some models are straight, others havedeflectable tips. The CCDs in Olympus endoscopes support high-definition
imaging. Focusing is unnecessary due to their broad depth of field.
Surgical videoscope●

Rigid Endoscope (Telescope)

A wide variety of telescopes are used for various types of diagnosis andtreatment. Uses in urology include transurethral prostatectomy and nephrectomy(kidney removal). Uses in ear, nose, and throat include viewing, diagnosing, andtreating the eardrum, nasal cavity, and vocal cords, which is performed using athin rigid endoscope. Rigid endoscopes are also used for myomectomy ingynecology and for viewing, diagnosing, and treating inside joint cavities inorthopedics.

3●

Peripherals

Insufflator

The insufflator feeds carbon dioxide gas into the abdominal cavity in order toexpand it and create a working space to perform surgery. A special insufflationneedle (Veress needle) delivers the carbon dioxide gas to the peritoneal cavity.
The insufflator monitors the pressure of the peritoneal cavity and automaticallypumps in additional gas as needed to make up for gas that naturally leaks out
during surgery.

●

Rigid endoscope (Telescope)

Insufflator

Imaging Management Hub

Imaging management hub simplifies the process of recording, managing, andediting high-resolution endoscopic images (video and still images).

Imaging management hub

36Appendix●

Trocar

Trocars are used to create an opening (portal) for passing endoscopic
instrumentation into the body. The endoscope, forceps, electrosurgical knives,
hemostatic/suturing equipment, etc., are then inserted through the trocar asneeded for surgery. Olympus offers various types of trocars, such as ones thatare available in diameters ranging from 5-15mm, ones that have an anti-slip
balloon, and a threaded type. Currently, the most common trocars come witha sheath and are single-use.

●

5mm

11mm

12mm

ForcepsThere are various kinds of forceps—such as grasping forceps that hold tissue andneedles, dissecting forceps that mechanically separates tissue, scissor forceps
for cutting tissue, etc.

Forceps

Tip of grasping forceps

●

15mm

TrocarTip of dissecting forceps

Hemostasis Clip

In endoscopic surgery, clips are often used to quickly close a blood vessel andstop bleeding that cannot be controlled by other means. The clips are held in apistol-shaped clip applier. Clips are applied repeatedly like a stapler.

Hemostatic clip (image)●

Ultrasonic Energy Device

Ultrasonic devices for coagulation and cutting by converting electricity into
ultrasonic vibrations. The heat is generated when the tip of the device (scissors)
contacts the tissue and then cuts the tissue and causes coagulation (hemostasis).

血管封止力

生体モデルの腸間膜（）
による社内机上試験

血管耐圧

出力レベル
血管サイズ

Ultrasonic energy device●

High-Frequency Electrosurgical Device (Electrode)

Olympus has commercialized electrosurgical knives that use high-frequency
currents as an energy source. These devices come in two types, monopolar with
one electrode and bipolar with two electrodes. Bipolar knives in particular arecapable of ablation for small lesions, for example. This minimizes the risk ofthermal damage to surrounding tissue.

●

High-frequency electrosurgical device (Electrode)

Fully-Integrated Bipolar / Ultrasonic Energy Devices

Combining the excellent hemostatic capabilities (controlling bleeding) ofbipolar high-frequency energy with precise dissection of ultrasonic energy, theenergy device can perform multiple tasks of vessel sealing, hemostasis,
coagulation, incision, and dissection in one unit. The device meets surgeon ’sdemands for superior medical effectiveness.
Bipolar & ultrasonic energy devices

37Appendix

The History of ESD: GI Endoscopy

1950

Development of the World sFirst Practical Gastrocamera

In 1949, with the request of Dr. Tatsuro Uji(Department of Surgery, the University ofTokyo Hospital Koishikawa Branch) that he“ somehow wants to cure the stomach cancer
that afflicts so many Japanese people, ”theOlympus technical team began developmentof a gastrocamera. After developing
numerous essential technologies such as aminiature lamp to illuminate the inside of thestomach, a wide-angle lens to capture alarge field of view, a device for winding thefilm, and choosing materials to construct theflexible tube used to inserted the miniaturecamera into the patient, they succeeded indeveloping a prototype in 1950 andcommercialized and launched it two years
later in 1952. They continued theiraggressive work with doctors to improve thedevice, and, in turn, physicians worked on
rapidly developing techniques for diagnosing
ailments of the digestive organs.

1964

1983

Introduction of the Fiberscope

Introduction of Endoscopic
Ultrasound System

However, there was a problem with the gastrocamera. Unlike thegastroscope, it could not view the inside of the stomach directly, in realtime. The device blindly took photographs of the stomach ’s interior andthe film had to be processed before the doctor could see what thegastrocamera saw. What solved this problem was the development of thefiberscope, introduced in 1957.
In 1964, with a gastrocamera already able to take sharp photographsof the stomach, Olympus released a gastrocamera with a fiberscopeattached. This combined instrument allowed the doctor to both observe
the stomach in real time and to take high-quality photographs for
documentation. Olympus ’reputation in the medical field grew. A
fiberscope is made up of tens of thousands of optical fibers; each fiberwith a diameter of 8 microns, a width approximately 1/10th of a humanhair. As the image is transmitted optically, the endoscope itself can bend.
Since doctors were now able to directly see inside the patient's body,techniques necessary for examination became easier, and the fiberscope ’spopularity quickly spread. The diagnostic area also expanded to theesophagus, duodenum, large intestine, bronchial tubes, and bile ducts.
Furthermore, the real-time image of the fiberscope allowed medical
treatment to be performed through endoscopes, which was a tremendous
advantage. By inserting devices through a instrument channel andperforming surgery on a tumor while looking inside the body in real time,minimally invasive procedures became possible, and reducing
doctors ’reliance on surgical scalpels.

■The History of Gastrointestinal Endoscopy
Roots in Ancient Greece“ I want to view the inside of a human. I want to unravel the mysteries of life. ”

Since ancient times, there has been a quest to find a way to observe the inside of
the human body. It began with Hippocrates, the father of medicine, and ancient
Greece in the 4th Century BCE. Horses were important for transportation backthen and many people developed hemorrhoids from riding. By using a device,
said to be the first endoscope, to observe the interior of the anus, thehemorrhoids were able to be healed through burning. Many centuries later,
modern endoscopes began with the“ Light Conductor, ”made in 1805 by theGerman physician Philipp Bozzini. It looked like a lantern and by inserting a metal
tube into the urethra, rectum, or pharynx, the light would help with observations.

Named the "Endoscope" in France
In 1853, the French physician, A.J.
Desormeaux, created a device forobserving the urethra and bladder. This
was the first time the term
“ endoscope ”was used.

The First Practical Gastroscope
The first practical gastroscope appeared in 1932. It was the flexible gastroscope developed by German physician, Rudolf
Schindler. It had a length of 75cm, a diameter of 11mm, and a third of the tip was curved slightly. However, since thisendoscope was essentially a metal tube that was inserted into the body, the procedure was painful for the patient, and there
was a possibility of accidents, such as perforation of the GI tract. Prior to WWII, their use was limited only to parts of Europe
and Japan.

38

Appendix

1985

2002

2020

Introduction of EVIS 1
Endoscopic Video System

Introduction of EVIS LUCERA̶
the World s First High-Definition
Endoscopic Video System

Introduction of EVIS X1
Endoscopy System

In 1983, the videoscope was initiallyintroduced in the U.S. While this first
instrument was ground-breaking,
Olympus ’own initial offering, released
in 1985, was seen as a significant
improvement. A videoscope has an
imaging element such as a charge
coupled device (CCD) built into its
distal tip. The image captured by thissensor is converted to a video signal
and is then displayed on a monitor for
all in the room to see. This allowed
multiple doctors and healthcare
professionals to observe
simultaneously, and diagnostic
accuracy increased rapidly. Following
the introduction of videoscopes, there
continued to be numerous
technological advances, such as
high-definition imaging, Narrow Band
Imaging (NBI) and much more.
Videoscopes have dramaticallyincreased the endoscope ’s diagnostic
and therapeutic potential.

In 2002, Olympus developed theworld ’
s first high-definition endoscopic
video system. By combining advanced
imaging technologies, it became
possible to provide improved image
accuracy capable of detecting eventhe smallest of lesions. The system
was equipped with more advanced
image processing technologies,
including the index of hemoglobin(IHb) color enhancement function thathighlights slight changes in mucous
membrane color — the IHb pseudocolor display function that makes
lesions that are normally difficult to see
during observation clearly visible — andan electronic magnification function forvideo and still images.

In 2020, Olympus launched the EVIS
X1 endoscopy system. As of February
2024, the system is marketed inJapan, U.S., Europe, China, and partsof Asia. Our most advanced endoscopy
system to date, EVIS X1 hasundergone a model change from theprevious models for the first time inabout eight years. Aiming to improve
the quality of endoscopic procedure in
the detection, characterization,
staging, and treatment of irregularlesions, as well as examination
efficiency by endoscopy, the EVIS X1
system contributes to early detection,
early diagnosis, and minimally invasive
treatment of gastrointestinal diseases
such as cancer by being equipped witha variety of new technologies.

Examinations with Street Performers
The first person in the world to successfully observe the stomach was the German physician, Adolph Kussmaul. In 1868,
expanding on Desormeaux's endoscope, he fashioned a metal pipe with a length of 47cm and a diameter of 13mm in his
medical equipment shop, and performed an examination on a sword-swallower. However, the lamp produced an insufficientamount of light, and he could not adequately illuminate the inside of the body. Therefore, there was no practical endoscope
until the introduction of electric lighting. In 1879, the Germany physician, Maximilian Nitze, and the Austrian electricalengineer, Joseph Leiter, made a cystoscope using an electric light as the source. They then went on to construct anesophagoscope and a gastroscope. In 1881, the Polish physician, Jan Mikulicz-Radecki, with the help of Leiter, created arigid gastroscope where the first third of the tip was curved.

1950 OLYMPUS
The Idea of the Gastrocamera
However, the idea of a stomach camera that has anultra-small camera attached to the tip of a flexible tube andwhich could take pictures inside the digestive tract emergedin Europe and the U.S. at the end of the 19th century. In
1898, the developments of two German physicians, Fritz
Lange and Carl Meltzing, were presented, but as the images
obtained were blurry, they proved to be impractical.

Development of the World s First Practical Gastrocamera(See above for the rest of our Company’s history.)

39

Appendix

The History of ESD: Surgical Endoscopy

1975

1986

1996

Launch of Laparoscope

Olympus First Medical TV System
for Surgery LaunchedVideo Systems to Meet Diverse
Needs

In the area of surgical endoscopy,
Olympus began selling laparoscopesfrom the German rigid scope
manufacturer, Winter & Ibe GmbH
(W&I, later OWI), in 1975. At that time,
laparoscopes were used in gynecology
for purposes such as sterilization, andin internal medicine for procedures that
included observing the surface of theliver and collecting tissue for the
diagnosis of liver diseases.

After that, there was a growing need toattach a video camera to a rigid
endoscope and for its images to beobserved on a monitor. Therefore,
Olympus began developing a TV
system as an imaging device forsurgery.
In 1986, Olympus developed andlaunched its first medical TV system,
the OTV-S, for use with rigid
endoscopes for surgical applications.
Subsequently, Olympus undertook
development of many products, andtheir imaging equipment significantly
supported the advance andwidespread adoption of rigid
endoscope examinations using amonitor during surgery.

In operating rooms, a wide variety ofdedicated endoscope designs wereavailable to meet the needs of each
medical specialty. In 1996, Olympus
introduced the OTV-S5 video system,an Olympus Endoscopy System (OES)
allowing multiple types of camera
heads and videoscopes to beconnected for various needs. The
OTV-S5 served as a surgical imaging
system, rather than just a video camera
attached to a rigid scope. In 1999,
Olympus also introduced the OTV-S6
video system that included a lineup ofcamera heads, which could withstandthe autoclave (high-pressure steam)used to sterilize many instruments inoperating rooms.

■The History of Endoscopic Surgery
1975 OLYMPUS
Roots in Pulmonary Tuberculosis Treatment
The history of endoscopic surgery goes back to 1910, whenthoracoscopes were used in the treatment of pulmonary
tuberculosis. In the 1960s, endoscopes were being used in
the areas of urology and gynecology in Europe. They
became a common way to treat urinary stones.

Launch of Laparoscope(See above for the rest of our Company’s history.)

The Accomplishments of Mouret
However, the man who was instrumental in the spread of endoscopic surgery was the French surgeon, Philippe Mouret. In
1987, he performed a gallbladder removal by attaching a CCD camera to the laparoscope and projecting the resulting video
image on a TV monitor. He established the current style of laparoscopic surgery where the surgery is performed cooperatively
in the view of doctors, assistants, and engineers. The first endoscopic gallbladder removal in Japan was performed in 1990
by Professor Tatsuro Yamakawa of Teikyo University. Starting in 1991, endoscopes were being used to resect the stomach
for the treatment of stomach cancer. Since the early 1990s there have been many technological advancements in addition to
the accelerated clinical use of endoscopic surgery. As stated previously, a key development was the coupling of endoscopes
to external CCD cameras. The ability to view the operation on a video monitor allowed for a high level of cooperation
between doctors and their assistants. The development of devices and equipment for surgery in body cavities that cannot bereached directly by hand progressed rapidly.

40Appendix

2015

2021

2022

Launched VISERA 4K UHD SurgicalEndoscopy System Incorporating 4K
Technology

Expanding Fluorescence Imaging
Market Portfolio

Launched VISERA ELITE III SurgicalEndoscopy System

Sony Olympus Medical Solutions wasestablished in 2013 as a joint venturewith Sony. The joint venture launched
its first product in 2015, a surgicalendoscope system incorporating 4K
technology that provided surgeons
with added value during endoscopic
procedures through the use ofhigh-resolution images, a wide color
range and a wide field of view.

In 2021, Olympus made the Dutch
medical equipment manufacturer,
Quest Photonic Devices B.V., a wholly
owned subsidiary.
Olympus thereby acquired
fluorescence imaging technology thatmakes the blood vessels under surface
tissue visible by combining near-infrared light and fluorescent dyes, so thatthe fluorescent agents flowing in the
bloodstream shine. We look forward to
expanding our portfolio in the rapidly
expanding fluorescence imaging
market and researching and developing
next-generation molecular imaging
technologies.

In 2022, Olympus launched VISERAELITE III that offers surgicalvisualization features including 4K, 3D,
infrared (IR) imaging, all supported in
one system. Future software upgrades
will advance surgical imaging
technology and allow for individual
configurations that facilitate seamlesssupport of various surgicalapplications. VISERA ELITE III features
Sony ’
s cutting-edge digital imaging
technology enhanced by leading
endoscope manufacturer Olympus ’expertise in manufacturing medical
equipment and understanding the needof medical facilities. Sony Olympus
Medical Solutions has leveraged thesecapabilities to develop the system ’sessential technologies and to optimize
medical device image processing.

Beginning of Endoscoptic Surgery
In 1978, the German surgeon, Kurt Semm, developed an automatic insufflator. The first known endoscopic surgery was anappendectomy performed by Kurt Semm in 1981. It was the first attempt to greatly change laparoscopy, from the traditional
approach through an orifice to an approach using an incision into the body. In 1985, the German surgeon, Erich Mühe,
performed an endoscopic gallbladder removal.

Health Insurance Coverage Starts in 1992
In Japan, starting in 1992 with gallbladder removal, endoscopic surgery is rapidly becoming covered by health insurance.
Hernioplasty, lung resection, and gynecological surgeries were covered by health insurance starting in 1994, stomach
resection in 1995, and 18 surgeries including splenectomy and liver removal in 1996.
Activities aimed at spreading endoscopic surgery are also popular in Japan. The Society for Endoscopic Surgery wasstarted in 1990, and the Japan Society for Endoscopic Surgery (JSES) was established in 1995. The goals of these societies
include both research and education. As of July 2008, membership was over 10,000. These societies foster increased
awareness of endoscopic surgery through various conferences and publications, and certify technical competence in thesenew procedures through their physician certification programs.

41

Appendix

The History of TSD: GI EndoTherapy

1966

Launched Olympus First Biopsy
Scope and Endotherapy Devices(Biopsy Forceps/Cytology Brushes)

In 1966, Olympus introduced a biopsy
fiberscope with an instrument channel topass endotherapy devices through theendoscope’s insertion tube. Along withconventional endoscopic image
diagnoses, it became possible to take asample of tissue using biopsy forceps tothen be examined by a pathologist
under a microscope. Endoscopic biopsy
greatly streamlined early-stage stomach
cancer diagnosis. Subsequently,
endotherapy devices were developed
separately from those for treatment andtherapy. By 1968, academic conferenceswere presented cases of excisingstomach polyps using a snare (wireloop), and using biopsy forceps throughwhich a high-frequency electric current
passed.

1970

ERCP

1975

EST

Clip hemostasis

Major Developments in Biliary Tract
and Pancreas Fields

Contributions to New Hemostasis
Techniques

In 1970, Olympus launched theduodenofiberscope, and there was great
progress made in diagnosis andtreatment in the biliary tract andpancreas fields. By using a cannula
while projecting X-rays of the biliary tract
and pancreas, physicians developed
techniques including endoscopic
retrograde cholangio pancreatography(ERCP) to detect tumors and otherlesions, and endoscopic sphincterotomy(EST) to widen the opening of theduodenal papilla with a high-frequency
scalpel.

In 1975, in response to the demand forless bleeding during endoscopic therapy
and hemostasis with an endoscope,
Olympus also launched an endotherapy
device called a coagulator to cauterize
and staunch sites of bleeding with ahigh-frequency electric current. In thesame year, Olympus also launched an
endoscopic clip that stops bleeding bydirectly grasping and pinching closed
the site of bleeding. After that,
improvements continued over the courseof 10 years, and clipping became widelyused for hemostasis and marking forresection.

The History of TSD: Urology

1972

42

1979

1986

Nephrofiberscope and rigid cystoscope

Cystofiberscope

Launch of Nephrofiberscope andDevelopment of Rigid Cystoscope

Acquisition of German Rigid
Endoscope Manufacturer

Improvements of Fiberscope andContribution to Minimally Invasive
Treatments

Diagnosis and treatment using rigid
endoscopes has long been performed in
the area of urology. With its origins ingastrocameras, Olympus was a
newcomer to the area. In 1970,
however, Olympus collaborated with the
Department of Urology in the Faculty of
Medicine at the University of Tokyo anddeveloped a nephrofiberscope thatallowed observation of the ureter andrenal pelvis without surgical incision. The
University of Tokyo was the first in theworld to use this scope in clinicalapplication.
In 1972, Olympus launched the KF
nephrofiberscope designed for use in
the kidneys while developing the
CYS-K1 rigid cystoscope.

In 1979, Olympus made the German
rigid endoscope manufacturer, Winter &Ibe GmbH (W&I), one of its subsidiaries
and established the company as amanufacturing base for Olympus’rigid
endoscopes. This move allowed
Olympus to acquire a rigid endoscope
lineup for the surgical market (including
the mainstay urology market) andaccelerate the expansion of its surgicalbusiness. By combining W&I’smanufacturing technology with Olympus’
optical technology, these new rigid
endoscopes had improved optics andoperability, as well as unprecedented
system functionality and design.

In 1986, Olympus introduced the CYF
cystofiberscope and strengthened its
initiatives in urology. Unlike rigid
endoscopes, the CYF’s flexible insertion
section contributed to alleviating patient
discomfort during examinations, and thebending mechanism at the tip of thefiberscope made it possible to observe awider area inside the bladder.
Progress in improving
ureterofiberscopes included the pursuitof a thinner insertion section, improved
optics, and improved insertability
resulting from adjustments to thediameter of the instrument channel andthe distal end design. Thereafter, they
became essential for the observationand treatment of the ureter.

Appendix

1980 s2002

2020

Electrosurgical knife

Colonoscope distal attachment

Resects Wider Range of Lesions

Resects Mucosa in Entire Areaaround Lesions

Expanding Lineup of Device to Treat
Gastrointestinal Disease

In the 1980s, endoscopic mucosal
resection (EMR) became practicalfollowing joint development byphysicians and Olympus. This is asurgical procedure by which saline water
is injected between lesioned tissue fromearly-stage stomach cancer or coloncancer and regular tissue to inflate thelesion, which is then removed by meansof a snare. Following the development ofdevices, endoscopic submucosal
dissection (ESD), which allows a wider
range of early-stage lesions to beendoscopically removed, was introduced
in 2002.

In 2002, Olympus developed theelectrosurgical knife, which reduced
perforation risks by adhering a ceramic
insulator to the tip of the needle-likeknife. In 2008, the electrosurgical knife,
which allowed adjusting the knife length
based on the intended use wasdeveloped. These endotherapy devices
have contributed to the development ofsafer procedures for resecting mucosa
in the entire area around a lesion.

In 2020, Olympus expanded its lineup of
gastrointestinal disease treatment
devices by acquiring the British medical
device manufacturer Arc Medical Design
Ltd. Having been designed to help
maintain and maximize visibility during acolonoscopy or endoscopic
polypectomy, the company’s flagship
ENDOCUFF VISION product is expected
to contribute to the early detection andtreatment of adenomatous polyps.

2005

2008

2020

EMRC

ESD

Electrode for TURis procedures

Ureterovideoscope

Gyrus energy device

Practical Application of the World sFirst Saline Prostatectomy

From Flexible Ureteroscopes toVideoscopes̶Strengthened sales
force in North America

In 2005, physicians developed a newprocedure called TURis (trans urethralresection in saline) for resecting enlarged
prostate. Olympus developed theworld’
s first endoscopic cutting loops
for TURis and a high-frequency powerdevice to control high-frequency
currents for ablation. With TURis, theentire circumference of the electrode ismade to discharge electricity andexcision takes place through anelectrolyte solution, which allows a morestable and higher level of cutting ability
than before.

In 2008, flexible ureteroscopes evolved
from fiberscopes to videoscopes.
In the same year, Olympus madethe U.S. company Gyrus ACMI Inc. oneof its subsidiaries. Gyrus ACMI had along history and was well respected in
the endoscopy area. It was particularly
known for its expertise in urology andotorhinolaryngology, as well as energy
application treatment devices centeredon electric scalpels. The sales force inNorth America, the largest market, wasstrengthened and the market share was
expanded.

Minimally invasive
treatment device for BPH

Thulium fiber laser system

Introduction of Even Less Invasive
Surgical Treatment Devices

In 2020, Olympus launched iTind, aminimally invasive treatment device for
BPH, and the SOLTIVE SuperPulsed
Laser System, a thulium fiber laser
device for dusting urinary stones intovery fine particles for easy discharge
from the body. Both are treatment
devices that contribute to reducing theburden placed on patients. By
introducing these products, Olympus will
provide physicians and patients withnew options and further enhance its
portfolio in the urology area.

43

Appendix

The History of TSD: Respiratory

44

1968

1993

1997

Bronchofiberscope

Bronchovideoscope

TBNA

Launch of Bronchofiberscope

Evolution from Fiberscope toVideoscope

Review of Endoscopic
Ultrasonography Procedures

In 1968, the bronchofiberscope for the
respiratory area was launched. Having
received high praise for its completed
products, the quality of their fiberoptics, and the comprehensive lineup
of scope types, Olympus
bronchofiberscopes sold well
worldwide. In particular, unlike othermanufacturers, Olympus gave scope
users the ability to select the mostappropriate insertion section
specification from diameters of 3mm,
4mm, or 5mm.

After this, improvements were made,giving rise to many fiberscope models,from scopes with a large 3.2mm
channel to scopes with an external
diameter of just 1.8mm.
Then the bronchofiberscope
evolved into the bronchovideoscope.
In 1993, three bronchovideoscopemodels were launched, and since then,the use of videoscope technology has
advanced even in the respiratory area,
where slim design is required.

Transbronchial needle aspiration(TBNA) is a method for diagnosing lungcancer by using aspiration biopsy froma lymph node on the extra-bronchialwall. The needle for this procedure isinserted through a bronchoscope.
Conventionally, the tip of the needle
could not be observed. In response torequests from physicians who wishedto utilize an ultrasound endoscope forthis procedure so that they could see
the needle, Olympus began reviewing
product specifications and developing
prototypes around 1997.

2004

2010

EBUS-TBNA system

Intrabronchial valve system

Widespread Adoption of Endoscopic
Ultrasound Procedures

Acquisition of Emphysema andPneumothorax Treatment Devices

After many reviews and the productionof prototypes, in 2004, Olympus
developed and launched an ultrasoundbronchoscope, which enabled
confirmation of the needle tip ’s location
during TBNA, and a specialized
aspiration needle. This led to thewidespread adoption of endoscopic
ultrasound TBNA and EBUS-TBNA(endobronchial ultrasoundtransbronchial needle aspiration) andcontributed to the realization of alymph node metastasis method that is
minimally invasive and possesses
advanced diagnostic capabilities.

In addition to diagnosing lung cancer,
Olympus also made full-scale efforts to
expand applications for endoscopes
for non-cancerous diseases. In 2010,
Olympus made Spiration, Inc. a
consolidated subsidiary. This U.S.
company handles minimally invasive
treatment devices for lung diseases,
such as emphysema andpneumothorax, and lung injuries.
Olympus would go on to accelerate thecompany ’s business by providing
bronchoscopic devices (valves) as aminimally invasive treatment for lungdiseases, which are on the rise.

Appendix

The History of the Olympus Medical BusinessYear

Main Accomplishments

Year

Main Accomplishments

1950

s first practical gastrocamera
Development of world’

2006

1952

Above-mentioned gastrocamera commercialized, announced as
GT-I

Established repair center for endoscopic products in Chinese
market2008

Gyrus plc. (UK) became subsidiary

1955

Gastrocamera Research Group established1964

GTF gastrocamera fiberscope released

Established new plant for the production of medical devices inVietnamEstablished training centers in Germany and China (Shanghai)

Established corporation in Europe
1966

GFB fiberscope for biopsy released

1968

Established corporation in U.S.

2009

Established medical equipment marketing company in India
Commenced operation at new factory in the Czech Republic

2010

Established training center in China (Beijing)

2011

Spirus Medical, Inc. (U.S.) became subsidiary

1974

Partnership with Winter & Ibe GmbH in Germany (entered into
surgical endoscopy area the next year)

1979

Winter & Ibe GmbH became subsidiary

Introduction of Surgical Imaging Platform VISERA ELITEs
Established U.S. location in California (currently the world’largest endoscope service center)

Olympus’NBI Technology recognized by the Japan Institute ofInvention and Innovation

1982

Introduction of endoscopic ultrasound system

1985

EVIS 1 endoscopic video system announced

1987

KeyMed Ltd. (UK) became subsidiary

1989

Established Beijing residential office
Established corporation in Singapore

2012

Introduction of EVIS EXERA III and EVIS LUCERA ELITE
gastrointestinal endoscopy systems
Introduction of THUNDERBEAT series of world-first composite
electrosurgical devices that combine bipolar high-frequency
current and ultrasonic energy

2013

Established Sony Olympus Medical Solutions Inc. (joint venturewith Sony Corporation)

1990

EVIS 100/200 series endoscopic video information systemannounced

1993

Established corporation in Russia

1999

Established corporation in Thailand

2000

Introduction of EVIS EXERA series endoscopic video system inEurope and North America

2015

Introduction of VISERA 4K UHD surgical endoscopy system
incorporating 4K technology

2001

Comprehensive partnership with Terumo Corporation for medical
equipment started

2016

Established training center in Thailand

2002

Introduction of VISERA series video system for endoscopic
surgery2017

s first high-definition endoscopic video
EVIS LUCERA–the world’system–released in Japan, the UK, and parts of Asia

2019

Established new global headquarters for Therapeutic Solutions
Division in the U.S.

2020

Introduction of EVIS X1 gastrointestinal endoscopy system

Launched 3D surgical videoscope system (launchedsimultaneously with a 3D videoscope featuring a world-first tip
bending function)
Established training center in China (Guangzhou)

Established corporation in Dubai

Image Stream Medical, Inc. (U.S.) became subsidiary

Established corporation in Brazil
2004

Established marketing/services company for medical equipment
in China

Acquisition of Arc Medical Design Ltd. (UK)

Celon AG (Germany) became subsidiary
2005

2006

Introduction of ENDO-AID AI-powered platform for theendoscopy system

Small intestine capsule endoscopy system introduced in Europe(expanded afterward to North America, Japan, and other regions)2021

Established center for repair of endoscopy products andmanagement of loan units in Japanese market (Shirakawa,
Fukushima Prefecture)

2022

Introduction of EVIS EXERA II and EVIS LUCERA SPECTRUM
endoscopic video systems that include NBI

Introduction of VISERA ELITE II surgical endoscope system

Acquisition of Quest Photonic Devices B.V. (Netherlands)
Acquisition of Medi-Tate Ltd. (Israel)
Introduction of VISERA ELITE III surgical visualization platform
Acquisition of Odin Medical (Odin Vision) Ltd. (UK)Introduction of VISERA PRO surgical video endoscopy system
Established service company in Vietnam (now also responsible
for sales)

Blue items indicate the establishment of new locations and subsidiaries.

References (in order of publication date)
Yoshimura Akira,“Bright Walls”(Shinchōsha, 1984)
Tamura Kimihide and Fujita Rikiya,“Nursing Mook–Continuing Nursing Education”(Gakusyukenkyusha, 2003)
Tanaka Masao and Shimizu Shuji,“Explaining Endoscopic Testing, Treatment, and Care”(Shorinsha, 2004)
Tanuma Kumiko, Masuda Ritsuko, and Saegusa Hideto, Encyclopedia on the Structure and Diseases of the Body (Seibido Shuppan, 2007)
Kurokawa Yoshimochi,“Explaining Recent Endoscopic Surgery”(Houken, 2007)
The Journal of the Japan Medical Association,“Special Issue: The State of Endoscopic Surgery and Visions for the Future”(Dec. 2008, Vol. 137 Issue 9)
Nippon Rinsho,“Special Issue: The Cutting Edge of Endoscopy and Endoscopic Surgery–The Progress of Minimally-Invasive Therapy”(July 2010, Vol. 68 Issue 7)
NPO Committee to Encourage New Surgeons,“The Day You Become a Surgeon”(Kodansha, 2010)
Niwa Hirofumi,“History of the Digestive Endoscope”(Nihon Medical Center, 2010)45